MOUNTAIN WEST DERM-BLACKHART, PLLC
NPI 1316656994
Dermatology in Tigard, OR

Q: What is Mountain West Derm-Blackhart, PLLC's NPI number?

The NPI number for Mountain West Derm-Blackhart, PLLC is 1316656994. It was assigned to this organization in the NPPES registry on November 22, 2022.

Q: What is Mountain West Derm-Blackhart, PLLC's specialty?

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

Active since November 22, 2022

10215 SW HALL BLVD, TIGARD, OR 97223(503) 245-2415(503) 244-5963 Get Directions Write a Review

NPPES record last updated: November 22, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Mountain West Derm-blackhart, Pllc NPPES

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

MOUNTAIN WEST DERM-BLACKHART, PLLC (NPI 1316656994) is a healthcare organization registered as a dermatology in Tigard, Oregon and active in the NPI registry since November 2022. The organization lists Jeffrey B Shackelton, Owner, as its authorized official.

NPPES Registry Identity

NPI1316656994

Entity TypeOrganization

Primary Taxonomy207N00000X

Legal Business NameMOUNTAIN WEST DERM-BLACKHART, PLLC

Location Address10215 SW HALL BLVDTigard, OR 97223-8809

Mailing Address10215 Sw Hall BlvdTigard, OR 97223-8809 · (503) 245-2415 · Fax (503) 244-5963

Phone(503) 245-2415

Fax(503) 244-5963

Organization SubpartYes

Authorized OfficialJeffrey B ShackeltonOwner · (775) 283-4086

Enumeration DateNovember 22, 2022

NPPES CertifiedNovember 22, 2022

✔ NPI 1316656994 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.

10215 SW HALL BLVD, Tigard, OR 97223

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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

Accepted Insurance

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

Mountain West Derm-blackhart, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 25 clinicians reassign Medicare billing to Mountain West Derm-Blackhart, PLLC, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 9 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 3

Dermatology20

Nurse Practitioner4

Micrographic Dermatologic Surgery (MDS)1

Nearest to this location (20)

See all 25

Colton Hafeman, DNP, FNP-BC

Nurse Practitioner

NPI 1639643943