IMAGE DERMATOLOGY PC
NPI 1104027556
Specialist in Montclair, NJ
About Image Dermatology Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IMAGE DERMATOLOGY PC (NPI 1104027556) is a healthcare organization registered as a specialist in Montclair, New Jersey and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through April 13, 2027 and lists Jeanine B. Downie, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Image Dermatology Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Image Dermatology PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 31D2094278
Image Dermatology, PC · Montclair, NJFrequently 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 Image Dermatology PC's NPI number?
The NPI number for Image Dermatology PC is 1104027556. It was assigned to this organization in the NPPES registry on May 31, 2007.
Where is Image Dermatology PC located?
Image Dermatology PC is located at 51 Park St, Montclair, NJ 07042. The listed phone number is (973) 509-6900.
What is Image Dermatology PC's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Image Dermatology PC enrolled in Medicare?
Yes. Image Dermatology PC is registered in the Medicare PECOS enrollment system.
When is Image Dermatology PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New Jersey, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Image Dermatology PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Image Dermatology PC. 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 Image Dermatology PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 31D2094278) is associated with this NPI, valid through April 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Image Dermatology PC was last updated on January 24, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.
# Image Dermatology Pc · NPI 1104027556
Specialist organization in Montclair, New Jersey. Organization record, active in the CMS NPPES registry since May 31, 2007.
## Identity
- **NPI:** 1104027556 (Entity type: Organization)
- **Enumerated:** May 31, 2007
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Organization subpart:** No
- **Authorized official:** Jeanine Downie, OWNER
## Practice location
- **Address:** 51 PARK ST, Montclair, NJ 07042-3439
- **Phone:** (973) 509-6900 · **Fax:** (973) 509-6939
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, New Jersey, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Dermatology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 24, 2008
- **Other identifiers:** Medicare PIN 951568 (NJ); Medicare UPIN G51843 (NJ)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104027556) · Data from the CMS NPPES public registry.