BLUE VALLEY DERMATOLOGY LLC
NPI 1104354794
Dermatology in Overland Park, KS
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
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Accepted 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)
Blue Valley Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
9Medicare enrollment records show 9 clinicians reassign Medicare billing to Blue Valley Dermatology LLC, which bills Medicare for the services they deliver. Of these, 6 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (9)
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 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, KSCertificate of Compliance 17D2318708
Blue Valley Dermatology Lenexa · Lenexa, KSFrequently 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.
Is Blue Valley Dermatology LLC enrolled in Medicare?
Yes. Blue Valley Dermatology LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Blue Valley Dermatology LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 3 Medicare specialties reassign their Medicare billing to Blue Valley Dermatology LLC. 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. The largest specialties are Nurse Practitioner (4), Dermatology (3) and Pathology (2). Of these, 6 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Sunflower Health Plan, Ambetter of Oklahoma and Anthem Blue Cross and Blue Shield 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 5 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.
# Blue Valley Dermatology Llc · NPI 1104354794
Dermatology organization in Overland Park, Kansas. Organization record, active in the CMS NPPES registry since May 26, 2017.
## Identity
- **NPI:** 1104354794 (Entity type: Organization)
- **Enumerated:** May 26, 2017
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Tom Tkachuk, MANAGER
## Practice location
- **Address:** 7840 W 165TH STREET, SUITE 260, Overland Park, KS 66223
- **Phone:** (415) 802-1310
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 9 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (4), Dermatology (3), Pathology (2); 6 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 25, 2021
- **CLIA laboratory certificates:** 2 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1104354794) · Data from the CMS NPPES public registry.