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DESTINATION DERMATOLOGY LLC
NPI 1205368453
Clinic/Center - Medical Specialty in Frisco, CO

Active since March 28, 2017
60 MAIN STREET, STE F, G & H, FRISCO, CO 80443(309) 287-1909 Get Directions Write a Review

NPPES record last updated: June 16, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Destination Dermatology Llc NPPES

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

DESTINATION DERMATOLOGY LLC (NPI 1205368453), doing business as Renew Dermatology, is a healthcare organization registered as a medical specialty in Frisco, Colorado and active in the NPI registry since March 2017. The organization lists Kelly Ann Ballou, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1205368453
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameDESTINATION DERMATOLOGY LLC
Location Address60 MAIN STREET, STE F, G & HFrisco, CO 80443
Mailing Address400 N Park Ave, Ste 12-b #1178Breckenridge, CO 80424 · (970) 409-4000 · Fax (855) 839-5617
Phone(309) 287-1909
Organization SubpartNo
Authorized OfficialKelly Ann BallouManaging Member · (970) 409-4000
Enumeration DateMarch 28, 2017
Last NPPES UpdateJune 16, 2026
NPPES CertifiedJune 16, 2026
✔ NPI 1205368453 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in CO · PA0004388
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).
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
60 MAIN STREET, Frisco, CO 80443
Open in Google Maps ↗

Other Names 1

Doing Business AsRenew Dermatology

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Destination Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

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

Clinician (1)

Scott Bennion, M.D.
Dermatology
NPI 1952317505
2546 E 2ND ST STE 400
Casper, WY 82609
(307) 234-0003
✔ PECOS226 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 Destination Dermatology LLC's NPI number?

The NPI number for Destination Dermatology LLC is 1205368453. It was assigned to this organization in the NPPES registry on March 28, 2017. The provider is doing business as Renew Dermatology.

Where is Destination Dermatology LLC located?

Destination Dermatology LLC is located at 60 Main Street Ste F, G & H, Frisco, CO 80443. The listed phone number is (309) 287-1909.

What is Destination Dermatology LLC's specialty?

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

Is Destination Dermatology LLC enrolled in Medicare?

Yes. Destination Dermatology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Destination Dermatology LLC?

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

When was this NPI record last updated?

The NPPES record for Destination Dermatology LLC was last updated on June 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.