HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC
NPI 1255449898
Dermatology - MOHS-Micrographic Surgery in Idaho Falls, ID

NPI Status: Active since August 25, 2006

Contact Information

2375 E SUNNYSIDE RD STE J
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 525-4888
Fax: (208) 525-4885

NPI Profile Information
Primary Taxonomy
Group Taxonomy
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Dermatology
MOHS-Micrographic Surgery
CLIA Number: 13D0927132
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 12-01-2025

About HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC

This page provides the complete NPI Profile along with additional information for High Valley Dermatology & Dermatologic Surgery, Pc, a provider established in Idaho Falls, Idaho operating as a Dermatology, focusing in mohs-micrographic surgery . The healthcare provider is registered in the NPI registry with number 1255449898 assigned on August 2006. The practitioner's primary taxonomy code is 207ND0101X with license number M7012 (ID). The provider is registered as an organization and their NPI record was last updated 5 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is James R Willis M.d. (President)

NPI: 1255449898
Provider Name: HIGH VALLEY DERMATOLOGY & DERMATOLOGIC SURGERY, PC
Entity Type: Organization
Location Address: 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404
Location Phone: (208) 525-4888
Location Fax: (208) 525-4885
Mailing Address: 2375 E SUNNYSIDE RD STE J IDAHO FALLS, ID 83404
Mailing Phone: (208) 525-4888
Mailing Fax: (208) 525-4885
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 08-25-2006
Last Update Date: 08-22-2020
Code Navigator

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Dermatology MOHS-Micrographic Surgery
Taxonomy Code: 207ND0101X
Type: Allopathic & Osteopathic Physicians
License No.: M7012
License State: ID
Taxonomy Description: The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: JAMES R WILLIS M.D.
Authorized Official Title: PRESIDENT
Authorized Official Phone: (208) 525-4888

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 13D0927132
Facility Type: Physician Office
Certificate Effective Date: December 02, 2023
Certificate Expiration Date: December 01, 2025
Laboratory Director: BRANDON L. MINER
Certificate Type: Certificate of Compliance
Certificate Type Description: This CLIA certificate is issued to High Valley Dermatology & Dermatologic Surgery, Pc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	2	5	5	4	4	9	8	9	8
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	2	10	5	8	4	18	8	18
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 2 + 1 + 0 + 5 + 8 + 4 + 1 + 8 + 8 + 1 + 8 + 24 = 72
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 72 = 8									8

The NPI number 1255449898 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.