CONCIERGE DERMATOLOGY & SKIN SURGERY CENTER
NPI 1417442898
Dermatology - MOHS-Micrographic Surgery in Hancock, MI

Q: What is Concierge Dermatology & Skin Surgery Center's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Active since June 27, 2018CLIA 23D2256333 · Certificate of Compliance

500 CAMPUS DR, HANCOCK, MI 49930(906) 362-7546(413) 269-8079 Get Directions Write a Review

NPPES record last updated: October 31, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 31, 2018, Jun 27, 2018 (2 updates tracked since 2018).

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About Concierge Dermatology & Skin Surgery Center NPPES

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

CONCIERGE DERMATOLOGY & SKIN SURGERY CENTER (NPI 1417442898) is a healthcare organization registered as a mohs-micrographic surgery in Hancock, Michigan and active in the NPI registry since June 2018. The organization holds a CLIA Certificate of Compliance certificate valid through March 12, 2027, maintains 3 additional practice locations, and lists Mercy A Odueyungbo, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1417442898

Entity TypeOrganization

Primary Taxonomy207ND0101X

Legal Business NameCONCIERGE DERMATOLOGY & SKIN SURGERY CENTER

Location Address500 CAMPUS DRHancock, MI 49930

Mailing Address540 S Lakeshore Blvd Unit 34Marquette, MI 49855-4631 · (708) 833-9990

Phone(906) 362-7546

Fax(413) 269-8079

Organization SubpartNo

Authorized OfficialMercy A OdueyungboAuthorized Official · (906) 362-7546

Enumeration DateJune 27, 2018

Last NPPES UpdateOctober 31, 20182 updates tracked since enumeration

✔ NPI 1417442898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207ND0101X

Definition

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.

500 CAMPUS DR, Hancock, MI 49930

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Secondary Practice Locations 3

Location 11500 Sandpoint RdMunising, MI 49862-1406 · Phone (709) 833-9990

Location 218341 US Highway 41Lanse, MI 49946-8024 · Phone (906) 362-7546 · Fax (413) 269-8079

Location 3710 S Lincoln RdEscanaba, MI 49829-1292 · Phone (906) 362-7546 · Fax (413) 269-8079

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 Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.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)

Concierge Dermatology & Skin Surgery Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Concierge Dermatology & Skin Surgery Center, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (4)

Samantha Conklin, NP-C

Nurse Practitioner

NPI 1750798799

580 W COLLEGE AVE
Marquette, MI 49855

(906) 228-9440

✔ PECOS✔ Accepts Medicare69 mi

Kayela Asplund, NP-C

Nurse Practitioner

NPI 1750805727

325 E H STREET
Iron Mountain, MI 49801

(906) 774-3300

✔ PECOS✔ Accepts Medicare95 mi

Mercy Odueyungbo, M.D.,

Dermatology

NPI 1801107552

1500 SANDPOINT RD
Munising, MI 49862

(906) 362-7546

✔ PECOS✔ Accepts Medicare104 mi

Jennifer Baldwin, MD

Dermatology

NPI 1326023706

1610 MAXWELL DR STE 210
Hudson, WI 54016

(715) 386-4004

✔ PECOS✔ Accepts Medicare250 mi

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 of Compliance 23D2256333

Concierge Dermatology & Skin Surgery Center · Marquette, MI

Active · expires Mar 12, 2027

CLIA Number23D2256333

Laboratory TypePhysician Office

Certificate Effective DateMarch 13, 2025

Certificate Expiration DateMarch 12, 2027

Laboratory DirectorMercy A. Odueyungbo

Laboratory Phone(906) 362-7546

Laboratory LocationConcierge Dermatology & Skin Surgery Center101 W Washington Street Suite 105, Marquette, MI 49855

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Concierge Dermatology & Skin Surgery Center's NPI number?

The NPI number for Concierge Dermatology & Skin Surgery Center is 1417442898. It was assigned to this organization in the NPPES registry on June 27, 2018.

Where is Concierge Dermatology & Skin Surgery Center located?

Concierge Dermatology & Skin Surgery Center is located at 500 Campus Dr, Hancock, MI 49930. The listed phone number is (906) 362-7546.

What is Concierge Dermatology & Skin Surgery Center's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Concierge Dermatology & Skin Surgery Center enrolled in Medicare?

Yes. Concierge Dermatology & Skin Surgery Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Concierge Dermatology & Skin Surgery Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Concierge Dermatology & Skin Surgery Center, 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Concierge Dermatology & Skin Surgery Center hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 23D2256333) is associated with this NPI, valid through March 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Concierge Dermatology & Skin Surgery Center accept?

Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Concierge Dermatology & Skin Surgery Center 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 Concierge Dermatology & Skin Surgery Center was last updated on October 31, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.