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BLUE VALLEY DERMATOLOGY LLC
NPI 1104354794
Dermatology in Overland Park, KS

Active since May 26, 2017CLIA Certified · 2 labs
7840 W 165TH STREET, SUITE 260, OVERLAND PARK, KS 66223(415) 802-1310 Get Directions Write a Review

NPPES record last updated: October 25, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 9, 2020, Sep 12, 2017, May 26, 2017 (3 updates tracked since 2017).

About Blue Valley Dermatology Llc NPPES

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

BLUE VALLEY DERMATOLOGY LLC (NPI 1104354794) is a healthcare organization registered as a dermatology in Overland Park, Kansas and active in the NPI registry since May 2017. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Overland Park, and lists Tom Tkachuk, Manager, as its authorized official.

NPPES Registry Identity

NPI1104354794
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameBLUE VALLEY DERMATOLOGY LLC
Location Address7840 W 165TH STREET, SUITE 260Overland Park, KS 66223
Mailing Address7840 W 165th Street, Suite 260Overland Park, KS 66223 · (415) 802-1310
Phone(415) 802-1310
Organization SubpartNo
Authorized OfficialTom TkachukManager · (415) 802-1310
Enumeration DateMay 26, 2017
Last NPPES UpdateOctober 25, 20213 updates tracked since enumeration
NPPES CertifiedOctober 25, 2021
✔ NPI 1104354794 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in KS · 04-36968
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
7840 W 165TH STREET, Overland Park, KS 66223
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Secondary Practice Location 1

Location 17520 W 160th St Ste 100Overland Park, KS 66085-8137 · Phone (913) 871-8221 · Fax (913) 495-5456

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 Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 Compliance 17D1105979

Blue Valley Dermatology · Overland Park, KS
Active · expires Dec 27, 2027
CLIA Number17D1105979
Laboratory TypePhysician Office
Certificate Effective DateDecember 28, 2025
Certificate Expiration DateDecember 27, 2027
Laboratory DirectorLauren A. Kyle Tkachuk
Laboratory Phone(913) 871-8221
Laboratory LocationBlue Valley Dermatology7520 West 160th Street, Overland Park, KS 66085
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 17D2318708

Blue Valley Dermatology Lenexa · Lenexa, KS
Active · expires Feb 16, 2027
CLIA Number17D2318708
Laboratory TypePhysician Office
Certificate Effective DateFebruary 17, 2025
Certificate Expiration DateFebruary 16, 2027
Laboratory DirectorLauren A. Kyle Tkachuk
Laboratory Phone(913) 871-8221
Laboratory LocationBlue Valley Dermatology Lenexa12210 W 87th Street, Ste 180, Lenexa, KS 66215
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform 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 Blue Valley Dermatology LLC's NPI number?

The NPI number for Blue Valley Dermatology LLC is 1104354794. It was assigned to this organization in the NPPES registry on May 26, 2017.

Where is Blue Valley Dermatology LLC located?

Blue Valley Dermatology LLC is located at 7840 W 165th Street Suite 260, Overland Park, KS 66223. The listed phone number is (415) 802-1310.

What is Blue Valley Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Blue Valley Dermatology LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Blue Valley Dermatology LLC accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 1 other insurer list Blue Valley Dermatology LLC 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 Blue Valley Dermatology LLC was last updated on October 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.