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MOSAIC DERMATOLOGY PLLC
NPI 1245051390
Dermatology in West Fargo, ND

Active since October 22, 2024CLIA 35D2315212 · Microscopy
567 32ND AVE E STE 100, WEST FARGO, ND 58078(701) 941-3100(701) 941-3301 Get Directions Write a Review

NPPES record last updated: February 27, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Mosaic Dermatology Pllc NPPES

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

MOSAIC DERMATOLOGY PLLC (NPI 1245051390) is a healthcare organization registered as a dermatology in West Fargo, North Dakota and active in the NPI registry since October 2024. The organization holds a CLIA Microscopy certificate valid through December 8, 2026 and lists Joanne Montgomery, Owner, as its authorized official.

NPPES Registry Identity

NPI1245051390
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMOSAIC DERMATOLOGY PLLC
Location Address567 32ND AVE E STE 100West Fargo, ND 58078-8480
Mailing Address567 32nd Ave E Ste 100West Fargo, ND 58078-8480 · (701) 941-3100 · Fax (701) 941-3301
Phone(701) 941-3100
Fax(701) 941-3301
Organization SubpartNo
Authorized OfficialJoanne MontgomeryOwner · (312) 415-8615
Enumeration DateOctober 22, 2024
Last NPPES UpdateFebruary 27, 2025
NPPES CertifiedFebruary 27, 2025
✔ NPI 1245051390 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.
567 32ND AVE E STE 100, West Fargo, ND 58078
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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 Blue Cross Blue Shield of North Dakota, Sanford Health Plan.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)

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

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Mosaic Dermatology PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Joanne Montgomery, M.D.
Dermatology
NPI 1609040427
567 32ND AVE E STE 100
West Fargo, ND 58078
(701) 941-3100
✔ PECOS✔ Accepts MedicareSame address
Aleksey Ryan, DNP, APRN, FNP-C
Nurse Practitioner
NPI 1124959721
567 32ND AVE E STE 100
West Fargo, ND 58078
(701) 941-3100
✔ PECOSSame address

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 for Provider-Performed Microscopy Procedures (PPMP) 35D2315212

Mosaic Dermatology PLLC · West Fargo, ND
Active · expires Dec 8, 2026
CLIA Number35D2315212
Laboratory TypePhysician Office
Certificate Effective DateDecember 9, 2024
Certificate Expiration DateDecember 8, 2026
Laboratory DirectorJoanne Montgomery
Laboratory Phone(701) 941-3100
Laboratory LocationMosaic Dermatology PLLC567 32nd Ave E, Suite 100, West Fargo, ND 58078
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.

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 Mosaic Dermatology PLLC's NPI number?

The NPI number for Mosaic Dermatology PLLC is 1245051390. It was assigned to this organization in the NPPES registry on October 22, 2024.

Where is Mosaic Dermatology PLLC located?

Mosaic Dermatology PLLC is located at 567 32nd Ave E Ste 100, West Fargo, ND 58078. The listed phone number is (701) 941-3100.

What is Mosaic Dermatology PLLC's specialty?

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

Is Mosaic Dermatology PLLC enrolled in Medicare?

Yes. Mosaic Dermatology PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mosaic Dermatology PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Mosaic Dermatology PLLC, in Dermatology and Nurse Practitioner. 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 Mosaic Dermatology PLLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 35D2315212) is associated with this NPI, valid through December 8, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mosaic Dermatology PLLC accept?

Health plans from Blue Cross Blue Shield of North Dakota and Sanford Health Plan list Mosaic Dermatology 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 Mosaic Dermatology PLLC was last updated on February 27, 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.