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IDAHO SKIN INSTITUTE LLC
NPI 1184375867
Dermatology in Chubbuck, ID

Active since January 13, 2022CLIA Certified · 2 labs
147 W CHUBBUCK RD, CHUBBUCK, ID 83202(208) 238-7546(208) 237-9643 Get Directions Write a Review

NPPES record last updated: February 4, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 4, 2025, Nov 14, 2024, Jan 13, 2022 (3 updates tracked since 2022).

About Idaho Skin Institute Llc NPPES

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

IDAHO SKIN INSTITUTE LLC (NPI 1184375867) is a healthcare organization registered as a dermatology in Chubbuck, Idaho and active in the NPI registry since January 2022. The organization holds 2 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Earl Stoddard, Owner, as its authorized official.

NPPES Registry Identity

NPI1184375867
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameIDAHO SKIN INSTITUTE LLC
Location Address147 W CHUBBUCK RDChubbuck, ID 83202-2314
Mailing Address147 W Chubbuck RdChubbuck, ID 83202-2314 · (208) 238-7546 · Fax (208) 237-9643
Phone(208) 238-7546
Fax(208) 237-9643
Organization SubpartNo
Authorized OfficialEarl StoddardOwner · (208) 238-7546
Enumeration DateJanuary 13, 2022
Last NPPES UpdateFebruary 4, 20253 updates tracked since enumeration
NPPES CertifiedFebruary 4, 2025
✔ NPI 1184375867 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.
147 W CHUBBUCK RD, Chubbuck, ID 83202
Open in Google Maps ↗

Secondary Practice Locations 2

Location 11344 Hiland Ave Ste DBurley, ID 83318-1564 · Phone (208) 572-6005
Location 21411 Falls Ave E Ste 1002Twin Falls, ID 83301-3459 · Phone (208) 595-5424

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 Molina Healthcare.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)

Idaho Skin Institute Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Idaho Skin Institute LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (6)

Trevor Batty, D.O.
Dermatology
NPI 1558756106
147 W CHUBBUCK RD
Chubbuck, ID 83202
(208) 238-7546
✔ PECOS✔ Accepts MedicareSame address
Earl Stoddard, M.D.
Micrographic Dermatologic Surgery (MDS)
NPI 1760400238
147 W CHUBBUCK RD
Chubbuck, ID 83202
(208) 238-7546
✔ PECOS✔ Accepts MedicareSame address
Samantha Roche, FNP
Nurse Practitioner
NPI 1760366603
300 W 1400 S
Garland, UT 84312
(435) 257-3684
✔ PECOS✔ Accepts Medicare83 mi
David Griffin, MD
Micrographic Dermatologic Surgery (MDS)
NPI 1528696283
1411 FALLS AVE E STE 1002
Twin Falls, ID 83301
(208) 595-5424
✔ PECOS✔ Accepts Medicare104 mi
Sheva Khalafbeigi, MD
Pathology
NPI 1114456407
1 CRANBERRY HL
Lexington, MA 02421
(678) 679-9059
✔ PECOS✔ Accepts Medicare2,079 mi
Daniel Gonzalez
Dermatology
NPI 1336672716
4665 PONCE DE LEON BLVD
Coral Gables, FL 33146
(786) 464-0749
✔ PECOS✔ Accepts Medicare2,169 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 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 for Provider-Performed Microscopy Procedures (PPMP) 13D2170865

Idaho Skin Institute Of Burley · Burley, ID
Active · expires Aug 20, 2027
CLIA Number13D2170865
Laboratory TypePhysician Office
Certificate Effective DateAugust 21, 2025
Certificate Expiration DateAugust 20, 2027
Laboratory DirectorTrevor Batty
Laboratory Phone(208) 572-6005
Laboratory LocationIdaho Skin Institute Of Burley1344 Hiland Ave Ste D, Burley, ID 83318
CLIA data matches this NPI record on: Address 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.

Certificate of Compliance 13D2000081

Idaho Skin Institute Of Chubbuck · Chubbuck, ID
Active · expires Feb 16, 2027
CLIA Number13D2000081
Laboratory TypePhysician Office
Certificate Effective DateFebruary 17, 2025
Certificate Expiration DateFebruary 16, 2027
Laboratory DirectorEarl R. Stoddard
Laboratory Phone(208) 238-7546
Laboratory LocationIdaho Skin Institute Of Chubbuck147 W Chubbuck Rd, Chubbuck, ID 83202
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 Idaho Skin Institute LLC's NPI number?

The NPI number for Idaho Skin Institute LLC is 1184375867. It was assigned to this organization in the NPPES registry on January 13, 2022.

Where is Idaho Skin Institute LLC located?

Idaho Skin Institute LLC is located at 147 W Chubbuck Rd, Chubbuck, ID 83202. The listed phone number is (208) 238-7546.

What is Idaho Skin Institute LLC's specialty?

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

Is Idaho Skin Institute LLC enrolled in Medicare?

Yes. Idaho Skin Institute LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Idaho Skin Institute LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians reassign their Medicare billing to Idaho Skin Institute LLC, in Dermatology, Micrographic Dermatologic Surgery (MDS), Nurse Practitioner and Pathology. 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Idaho Skin Institute 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 Idaho Skin Institute LLC accept?

Health plans from Molina Healthcare list Idaho Skin Institute 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 Idaho Skin Institute LLC was last updated on February 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 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.