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: November 01, 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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bend Dermatology Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

25

Medicare enrollment records show 25 clinicians reassign Medicare billing to Bend Dermatology Clinic, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 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
Dermatology
NPI 1285860288
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1538366240
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1427282383
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1275744971
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1417207283
2450 NE MARY ROSE PL STE 201
Bend, OR 97701
(541) 585-7546
✔ PECOS✔ Accepts Medicare0.6 mi
Dermatology
NPI 1528476322
860 BELTLINE RD
Springfield, OR 97477
(541) 344-4168
✔ PECOS✔ Accepts Medicare88 mi
Nurse Practitioner
NPI 1972303857
1430 COMMERCIAL ST SE
Salem, OR 97302
(503) 364-5033
✔ PECOS106 mi
Dermatology
NPI 1013142116
9900 SE SUNNYSIDE RD NW PERMANENTE PC, PHYSICIANS AND SURGEONS
Clackamas, OR 97015
(503) 571-3332
✔ PECOS✔ Accepts Medicare114 mi
Nurse Practitioner
NPI 1952528895
25117 SW PARKWAY AVE STE B
Wilsonville, OR 97070
(503) 783-7243
✔ PECOS✔ Accepts Medicare115 mi
Dermatology
NPI 1467475137
341 MEDICAL LOOP STE 110
Roseburg, OR 97471
(541) 440-2165
✔ PECOS120 mi
Micrographic Dermatologic Surgery (MDS)
NPI 1558716944
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare120 mi
Nurse Practitioner
NPI 1639643943
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1679553218
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1164000352
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1295800860
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1023279064
5050 NE HOYT ST SUITE 540
Portland, OR 97213
(503) 215-6600
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1699090092
3303 SW BOND AVE # 16D OHSU
Portland, OR 97239
(503) 418-3376
✔ PECOS✔ Accepts Medicare121 mi
Dermatology
NPI 1578975991
3303 SW BOND AVE # 16D
Portland, OR 97239
(503) 418-3376
✔ PECOS✔ Accepts Medicare121 mi
Nurse Practitioner
NPI 1962971796
2900 STATE ST STE 101
Medford, OR 97504
(541) 789-5761
✔ PECOS✔ Accepts Medicare145 mi
Dermatology
NPI 1184699365
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS314 mi
See all 25 clinicians

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 7

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 38D2134456

Bend Dermatology Clinic-Klamath Falls · Klamath Falls, OR
Active · expires Oct 16, 2028
CLIA Number38D2134456
Laboratory TypePhysician Office
Certificate Effective DateOctober 17, 2026
Certificate Expiration DateOctober 16, 2028
Laboratory DirectorDr. Mariah M. Johnson
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic-Klamath Falls1900 Main Street, Suite A, Klamath Falls, OR 97601
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) 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 38D2052874

Bend Dermatology Clinic-Redmond · Redmond, OR
Active · expires Jul 8, 2028
CLIA Number38D2052874
Laboratory TypePhysician Office
Certificate Effective DateJuly 9, 2026
Certificate Expiration DateJuly 8, 2028
Laboratory DirectorMariah M. Johnson
Laboratory Phone(541) 382-5712
Laboratory LocationBend Dermatology Clinic-Redmond1475 NW 4th St, Redmond, OR 97756
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 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.

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.

Is Mountain West Derm - Blackhart PLLC enrolled in Medicare?

Yes. Mountain West Derm - Blackhart PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mountain West Derm - Blackhart PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 25 clinicians in 3 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 (20), Nurse Practitioner (4) and Micrographic Dermatologic Surgery (MDS) (1). Of these, 4 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.