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MOUNTAIN WEST DERM - BLACKHART PLLC
NPI 1124670088
Dermatology in Anchorage, AK

Active since July 11, 2019CLIA 02D1009028 · Certificate of Compliance
3841 PIPER ST STE T4-020, ANCHORAGE, AK 99508(907) 646-8500 Get Directions Write a Review

NPPES record last updated: August 18, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Mountain West Derm - Blackhart Pllc NPPES

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

MOUNTAIN WEST DERM - BLACKHART PLLC (NPI 1124670088), doing business as Alaska Center For Dermatology, is a healthcare organization registered as a dermatology in Anchorage, Alaska and active in the NPI registry since July 2019. The organization holds a CLIA Certificate of Compliance certificate valid through August 12, 2027, maintains a secondary practice location in Anchorage, and lists Bret S Blackhart, Owner, as its authorized official.

NPPES Registry Identity

NPI1124670088
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMOUNTAIN WEST DERM - BLACKHART PLLC
Location Address3841 PIPER ST STE T4-020Anchorage, AK 99508-4673
Mailing Address3841 Piper St Ste T4-020Anchorage, AK 99508-4673 · (775) 560-8668
Phone(907) 646-8500
Organization SubpartNo
Authorized OfficialBret S BlackhartOwner · (775) 560-8668
Enumeration DateJuly 11, 2019
Last NPPES UpdateAugust 18, 2025
NPPES CertifiedAugust 18, 2025
✔ NPI 1124670088 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
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.
3841 PIPER ST STE T4-020, Anchorage, AK 99508
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Other Names 1

Doing Business AsAlaska Center For Dermatology

Secondary Practice Location 1

Location 1188 W Northern Lights Blvd Ste 800Anchorage, AK 99503-3984 · Phone (907) 646-8500 · Fax (907) 646-8500

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 Moda Health Plan, Inc., Premera Blue Cross Blue Shield of Alaska.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)

Mountain West Derm - Blackhart Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

7

Medicare enrollment records show 7 clinicians reassign Medicare billing to Mountain West Derm - Blackhart PLLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.

Clinicians, nearest first (7)

Stephanie Mcleish, M.D.
Dermatology
NPI 1104850460
3841 PIPER ST STE T4-020
Anchorage, AK 99508
(907) 646-8500
✔ PECOSSame address
Michael Michener, MD
Dermatology
NPI 1467448662
3841 PIPER ST STE T4-020
Anchorage, AK 99508
(907) 646-8500
✔ PECOS✔ Accepts MedicareSame address
Robert Moreland, M.D.
Dermatology
NPI 1790712842
3841 PIPER ST STE T4-020
Anchorage, AK 99508
(907) 646-8500
✔ PECOS✔ Accepts MedicareSame address
Peter Ehrnstrom, M.D.
Dermatology
NPI 1689600439
3841 PIPER STREET SUITE T4-020
Anchorage, AK 99508
(907) 646-8500
✔ PECOS✔ Accepts MedicareSame address
Stephen Austad, DO
Dermatology
NPI 1679869119
123 C AVE
Lake Oswego, OR 97034
(541) 316-6575
✔ PECOS✔ Accepts Medicare1,545 mi
Michael Heaphy, M.D.
Dermatology
NPI 1174620496
4814 SPARKS BLVD
Sparks, NV 89436
(775) 324-0699
✔ PECOS✔ Accepts Medicare1,965 mi
Jeffrey Shackelton, M.D.
Dermatology
NPI 1699902726
640 W. MOANA LANE
Reno, NV 89509
(775) 324-0699
✔ PECOS✔ Accepts Medicare1,968 mi

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 Compliance 02D1009028

Mountain West Derm Blackhart PLLC Dba Alaska Center For Dermatology · Anchorage, AK
Active · expires Aug 12, 2027
CLIA Number02D1009028
Laboratory TypePhysician Office
Certificate Effective DateAugust 13, 2025
Certificate Expiration DateAugust 12, 2027
Laboratory DirectorDr. Peter G. Ehrnstrom
Laboratory Phone(907) 646-8500
Laboratory LocationMountain West Derm Blackhart PLLC Dba Alaska Center For Dermatology188 W Northern Lights Blvd, Ste 800, Anchorage, AK 99503
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.

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 Mountain West Derm - Blackhart PLLC's NPI number?

The NPI number for Mountain West Derm - Blackhart PLLC is 1124670088. It was assigned to this organization in the NPPES registry on July 11, 2019. The provider is doing business as Alaska Center for Dermatology.

Where is Mountain West Derm - Blackhart PLLC located?

Mountain West Derm - Blackhart PLLC is located at 3841 Piper St Ste T4-020, Anchorage, AK 99508. The listed phone number is (907) 646-8500.

What is Mountain West Derm - Blackhart PLLC's specialty?

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

Is Mountain West Derm - Blackhart PLLC enrolled in Medicare?

Yes. Mountain West Derm - Blackhart PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mountain West Derm - Blackhart PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians, all in Dermatology, reassign their Medicare billing to Mountain West Derm - Blackhart PLLC. 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. Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mountain West Derm - Blackhart PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 02D1009028) is associated with this NPI, valid through August 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mountain West Derm - Blackhart PLLC accept?

Health plans from Moda Health Plan, Inc. and Premera Blue Cross Blue Shield of Alaska list Mountain West Derm - Blackhart PLLC 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 Mountain West Derm - Blackhart PLLC was last updated on August 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.