MOUNTAIN WEST DERM - BLACKHART PLLC
NPI 1366018848
Dermatology in Georgetown, TX
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 1366018848), doing business as Vitalogy Skincare, is a healthcare organization registered as a dermatology in Georgetown, Texas and active in the NPI registry since June 2021. The organization lists Bret S Blackhart, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation 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).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
21Medicare enrollment records show 21 clinicians reassign Medicare billing to Mountain West Derm - Blackhart PLLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 7 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 4
Nearest to this location (20)
See all 21Source: 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 - Blackhart PLLC's NPI number?
The NPI number for Mountain West Derm - Blackhart PLLC is 1366018848. It was assigned to this organization in the NPPES registry on June 3, 2021. The provider is doing business as Vitalogy Skincare.
Where is Mountain West Derm - Blackhart PLLC located?
Mountain West Derm - Blackhart PLLC is located at 4513 Williams Dr, Georgetown, TX 78633. The listed phone number is (512) 930-3909.
What is Mountain West Derm - Blackhart PLLC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Mountain West Derm - Blackhart PLLC enrolled in Medicare?
Yes. Mountain West Derm - Blackhart PLLC is registered in the Medicare PECOS enrollment system.
When is Mountain West Derm - Blackhart PLLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Texas, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Mountain West Derm - Blackhart PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 21 clinicians in 4 Medicare specialties reassign their Medicare billing to Mountain West Derm - Blackhart PLLC. 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 (10), Micrographic Dermatologic Surgery (MDS) (5) and Pathology (4). Of these, 4 practice at this address and 7 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Mountain West Derm - Blackhart PLLC accept?
Health plans from Moda Health Plan, Inc., Sendero Health Plans, Local Nonprofit and WellPoint list Mountain West Derm - Blackhart 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 Mountain West Derm - Blackhart PLLC was last updated on June 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.
# Mountain West Derm - Blackhart Pllc · NPI 1366018848
Dermatology organization in Georgetown, Texas. Organization record, active in the CMS NPPES registry since June 3, 2021.
## Identity
- **NPI:** 1366018848 (Entity type: Organization)
- **Enumerated:** June 3, 2021
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Also known as:** Vitalogy Skincare (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Bret Blackhart, PRESIDENT
## Practice location
- **Address:** 4513 WILLIAMS DR, Georgetown, TX 78633-1302
- **Phone:** (512) 930-3909 · **Fax:** (512) 240-5469
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, Texas, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 21 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (10), Micrographic Dermatologic Surgery (MDS) (5), Pathology (4); 4 practice at this address and 7 within 10 miles; [full list](https://npiprofile.com/npi/1366018848/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 14, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1366018848) · Data from the CMS NPPES public registry.