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JORDAN VALLEY DERMATOLOGY
NPI 1073954913
Specialist in Casper, WY

Active since July 08, 2013CLIA 53D2092856 · Waiver
428 S DURBIN ST STE 103, CASPER, WY 82601(307) 234-0003(307) 265-6575 Get Directions Write a Review

NPPES record last updated: June 21, 2019. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Jordan Valley Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JORDAN VALLEY DERMATOLOGY (NPI 1073954913) is a healthcare organization registered as a specialist in Casper, Wyoming and active in the NPI registry since July 2013. The organization holds a CLIA Waiver certificate valid through March 15, 2027 and lists Virginia Louise Tubbs, Owner, as its authorized official.

NPPES Registry Identity

NPI1073954913
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameJORDAN VALLEY DERMATOLOGY
Location Address428 S DURBIN ST STE 103Casper, WY 82601-2829
Mailing Address428 S Durbin St Ste 103Casper, WY 82601-2829 · (307) 234-0003
Phone(307) 234-0003
Fax(307) 265-6575
Organization SubpartNo
Authorized OfficialVirginia Louise TubbsOwner · (307) 265-2936
Enumeration DateJuly 8, 2013
Last NPPES UpdateJune 21, 2019
✔ NPI 1073954913 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in UT · 8624096-4405
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
428 S DURBIN ST STE 103, Casper, WY 82601
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Other Names 1

Former Legal Business NameJordan Valley Dermatology

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Wyoming.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jordan Valley Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Jordan Valley Dermatology, which bills Medicare for the services this clinician delivers.

Clinician (1)

Virginia Tubbs, NURSE PRACTITIONER
Nurse Practitioner
NPI 1609034131
428 S DURBIN ST STE 103
Casper, WY 82601
(307) 265-2936
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 53D2092856

Jordan Valley Dermatology · Casper, WY
Active · expires Mar 15, 2027
CLIA Number53D2092856
Laboratory TypePhysician Office
Certificate Effective DateMarch 16, 2025
Certificate Expiration DateMarch 15, 2027
Laboratory DirectorVirginia L. Tubbs
Laboratory Phone(307) 265-2936
Laboratory LocationJordan Valley Dermatology428 South Durbin Suite 103, Casper, WY 82601
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jordan Valley Dermatology's NPI number?

The NPI number for Jordan Valley Dermatology is 1073954913. It was assigned to this organization in the NPPES registry on July 8, 2013.

Where is Jordan Valley Dermatology located?

Jordan Valley Dermatology is located at 428 S Durbin St Ste 103, Casper, WY 82601. The listed phone number is (307) 234-0003.

What is Jordan Valley Dermatology's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Jordan Valley Dermatology enrolled in Medicare?

Yes. Jordan Valley Dermatology is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jordan Valley Dermatology?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Jordan Valley Dermatology. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Jordan Valley Dermatology hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 53D2092856) is associated with this NPI, valid through March 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Jordan Valley Dermatology accept?

Health plans from Blue Cross Blue Shield of Wyoming list Jordan Valley Dermatology as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jordan Valley Dermatology was last updated on June 21, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.