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MOUNTAIN WEST DERM CALIFORNIA PC
NPI 1205346061
Dermatology in Truckee, CA

Active since October 06, 2017
10870 BROCKWAY RD, TRUCKEE, CA 96161(530) 550-0440(530) 582-8853 Get Directions Write a Review

NPPES record last updated: August 13, 2018. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Mountain West Derm California Pc NPPES

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

MOUNTAIN WEST DERM CALIFORNIA PC (NPI 1205346061) is a healthcare organization registered as a dermatology in Truckee, California and active in the NPI registry since October 2017. The organization lists Bret Blackhart, Md, as its authorized official.

NPPES Registry Identity

NPI1205346061
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMOUNTAIN WEST DERM CALIFORNIA PC
Location Address10870 BROCKWAY RDTruckee, CA 96161
Mailing Address10870 Brockway RdTruckee, CA 96161-2054 · (530) 550-0440 · Fax (530) 582-8853
Phone(530) 550-0440
Fax(530) 582-8853
Organization SubpartNo
Authorized OfficialBret BlackhartMd · (775) 560-8668
Enumeration DateOctober 6, 2017
Last NPPES UpdateAugust 13, 2018
✔ NPI 1205346061 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.
10870 BROCKWAY RD, Truckee, CA 96161
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 California Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Mountain West Derm California PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

John Hibler, DO
Dermatology
NPI 1588822670
10870 BROCKWAY RD
Truckee, CA 96161
(530) 550-0440
✔ PECOS✔ Accepts MedicareSame address
Dianne Kamenetsky, MD
Dermatology
NPI 1689701229
10870 BROCKWAY RD
Truckee, CA 96161
(530) 550-0440
✔ PECOS✔ Accepts MedicareSame address
Simone Jensen, FNP
Nurse Practitioner
NPI 1174973325
5452 RENO CORPORATE DR
Reno, NV 89511
(775) 245-2426
✔ PECOS✔ Accepts Medicare24 mi
Adam Wallach, M.D.
Dermatology
NPI 1982741021
400 EL CERRO BLVD SUITE 204
Danville, CA 94526
(925) 837-8848
✔ PECOS✔ Accepts Medicare143 mi

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 Mountain West Derm California PC's NPI number?

The NPI number for Mountain West Derm California PC is 1205346061. It was assigned to this organization in the NPPES registry on October 6, 2017.

Where is Mountain West Derm California PC located?

Mountain West Derm California PC is located at 10870 Brockway Rd, Truckee, CA 96161. The listed phone number is (530) 550-0440.

What is Mountain West Derm California PC's specialty?

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

Is Mountain West Derm California PC enrolled in Medicare?

Yes. Mountain West Derm California PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mountain West Derm California PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Mountain West Derm California PC. 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 Dermatology (3) and Nurse Practitioner (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Mountain West Derm California PC was last updated on August 13, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.