GRACE DERMATOLOGY & MICROGRAPHIC SURGERY LLC
NPI 1184973828
Clinic/Center - Medical Specialty in Lebanon, OR

Q: What is Grace Dermatology & Micrographic Surgery LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Active since September 07, 2012

2500 S MAIN RD, LEBANON, OR 97355(206) 465-8046 Get Directions Write a Review

NPPES record last updated: November 26, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Grace Dermatology & Micrographic Surgery Llc NPPES

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

GRACE DERMATOLOGY & MICROGRAPHIC SURGERY LLC (NPI 1184973828) is a healthcare organization registered as a medical specialty in Lebanon, Oregon and active in the NPI registry since September 2012. The organization lists Kyle Leland Horner, Owner, as its authorized official.

NPPES Registry Identity

NPI1184973828

Entity TypeOrganization

Primary Taxonomy261QM2500X

Legal Business NameGRACE DERMATOLOGY & MICROGRAPHIC SURGERY LLC

Location Address2500 S MAIN RDLebanon, OR 97355-2336

Mailing Address2500 S Main RdLebanon, OR 97355-2336 · (206) 465-8046

Phone(206) 465-8046

Organization SubpartNo

Authorized OfficialKyle Leland HornerOwner · (206) 465-8046

Enumeration DateSeptember 7, 2012

Last NPPES UpdateNovember 26, 2012

✔ NPI 1184973828 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM2500X

License✔ Licensed in OR · MD153145

Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

2500 S MAIN RD, Lebanon, OR 97355

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Providence Health Plan, Regence BlueCross BlueShield of Oregon.Insurance ›

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)

Grace Dermatology & Micrographic Surgery Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

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.

StateEnrollment IDDue date

StateOregonEnrollment IDO20121126000317Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026

Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Grace Dermatology & Micrographic Surgery LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kyle Horner, M.D.

Dermatology

NPI 1528124195

2500 S. MAIN ROAD
Lebanon, OR 97355

(541) 258-7546

✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Grace Dermatology & Micrographic Surgery LLC's NPI number?

The NPI number for Grace Dermatology & Micrographic Surgery LLC is 1184973828. It was assigned to this organization in the NPPES registry on September 7, 2012.

Where is Grace Dermatology & Micrographic Surgery LLC located?

Grace Dermatology & Micrographic Surgery LLC is located at 2500 S Main Rd, Lebanon, OR 97355. The listed phone number is (206) 465-8046.

What is Grace Dermatology & Micrographic Surgery LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Is Grace Dermatology & Micrographic Surgery LLC enrolled in Medicare?

Yes. Grace Dermatology & Micrographic Surgery LLC is registered in the Medicare PECOS enrollment system.

When is Grace Dermatology & Micrographic Surgery LLC'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 (Oregon, Clinic/Group Practice) is due for revalidation by November 30, 2026. 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 Grace Dermatology & Micrographic Surgery LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Grace Dermatology & Micrographic Surgery 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Grace Dermatology & Micrographic Surgery LLC accept?

Health plans from BridgeSpan Health Company, Providence Health Plan and Regence BlueCross BlueShield of Oregon list Grace Dermatology & Micrographic Surgery 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 Grace Dermatology & Micrographic Surgery LLC was last updated on November 26, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.