BEND DERMATOLOGY CLINIC
NPI 1447764741
Dermatology in Bend, OR

Active since November 22, 2017CLIA Certified · 7 labs
2747 NE CONNERS AVE, BEND, OR 97701(541) 382-5712 Get Directions Write a Review

NPPES record last updated: November 22, 2017. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Bend Dermatology Clinic NPPES

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

BEND DERMATOLOGY CLINIC (NPI 1447764741) is a healthcare organization registered as a dermatology in Bend, Oregon and active in the NPI registry since November 2017. The organization holds 7 active CLIA laboratory certificates and lists Bret S Blackhart, Md, as its authorized official.

NPPES Registry Identity

NPI1447764741
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMOUNTAIN WEST DERM - BLACKHART PLLC
Location Address2747 NE CONNERS AVEBend, OR 97701-8738
Mailing Address640 W Moana LnReno, NV 89509-4903 · (775) 324-0699
Organization SubpartNo
Authorized OfficialBret S BlackhartMd · (775) 336-3624
Enumeration DateNovember 22, 2017
NPI 1447764741 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.

2747 NE CONNERS AVE, Bend, OR 97701

Other Names 1

Doing Business AsBend Dermatology Clinic

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

CLIA Laboratory Certificates CMS CLIA 8

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 38D0628271

Bend Dermatology Clinic Lab LLC · Bend, OR
Active · expires Sep 19, 2026
CLIA Number38D0628271
Laboratory TypePhysician Office
Certificate Effective DateSeptember 20, 2024
Certificate Expiration DateSeptember 19, 2026
Laboratory DirectorStephanie A Trautman
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic Lab LLC2747 NE Conners Avenue, Bend, OR 97701
CLIA data matches this NPI record on: Address 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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 38D2264124

Bend Dermatology Clinic-Prineville · Prineville, OR
Active · expires Jul 10, 2028
CLIA Number38D2264124
Laboratory TypePhysician Office
Certificate Effective DateJuly 11, 2026
Certificate Expiration DateJuly 10, 2028
Laboratory DirectorJoshua S. May
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic-Prineville555 NW 3rd St, Prineville, OR 97754
CLIA data matches this NPI record on: 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.

Certificate of Compliance 38D1097454

Bend Dermatology Clinic - Main Lab · Bend, OR
Active · expires Aug 27, 2027
CLIA Number38D1097454
Laboratory TypePhysician Office
Certificate Effective DateAugust 28, 2025
Certificate Expiration DateAugust 27, 2027
Laboratory DirectorDr. Mariah M. Johnson
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic - Main Lab2705 NE Conners Avenue, Bend, OR 97701
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.

Certificate of Compliance 38D1097453

Bend Dermatology Clinic - Mohs · Bend, OR
Active · expires Jul 19, 2027
CLIA Number38D1097453
Laboratory TypePhysician Office
Certificate Effective DateJuly 20, 2025
Certificate Expiration DateJuly 19, 2027
Laboratory DirectorDr. Mariah M. Johnson
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic - Mohs2705 NE Conners Ave, Bend, OR 97701
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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 38D2324839

Bend Dermatology Clinic - Ashland · Ashland, OR
Active · expires Jun 1, 2027
CLIA Number38D2324839
Laboratory TypePhysician Office
Certificate Effective DateJune 2, 2025
Certificate Expiration DateJune 1, 2027
Laboratory DirectorJoshua S. May
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic - Ashland731 N Main Street, Ashland, OR 97520
CLIA data matches this NPI record on: 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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 38D2052873

Bend Dermatology Clinic West Side · Bend, OR
Active · expires Jan 21, 2027
CLIA Number38D2052873
Laboratory TypePhysician Office
Certificate Effective DateJanuary 22, 2025
Certificate Expiration DateJanuary 21, 2027
Laboratory DirectorStephanie A Trautman MD
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic West Side2855 NW Crossing Dr Suite 104, Bend, OR 97701
CLIA data matches this NPI record on: 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.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
2747 NE CONNERS AVE
BEND, OR 97701
Dermatology
2747 NE CONNERS AVE
BEND, OR 97701
Dermatology
2747 NE CONNERS AVE
BEND, OR 97701
Dermatology
2747 NE CONNERS AVE
BEND, OR 97701
Dermatology
2747 NE CONNERS AVE
BEND, OR 97701
Dermatology
2747 NE CONNERS AVE
BEND, OR 97701
Physician Assistant
2747 NE CONNERS AVE
BEND, OR 97701
Physician Assistant
2747 NE CONNERS AVE
BEND, OR 97701

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 1447764741. It was assigned to this organization in the NPPES registry on November 22, 2017. The provider is doing business as Bend Dermatology Clinic.

Where is Mountain West Derm - Blackhart PLLC located?

Mountain West Derm - Blackhart PLLC is located at 2747 NE Conners Ave, Bend, OR 97701. The listed phone number is (541) 382-5712.

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

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

Does Mountain West Derm - Blackhart PLLC hold CLIA laboratory certificates?

Yes. 7 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Mountain West Derm - Blackhart PLLC accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc., Providence Health Plan and Regence BlueCross BlueShield of Oregon 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 November 22, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.