LIVONIA DERMATOLOGY PLLC
NPI 1457406217
Dermatology in Livonia, MI
About Livonia Dermatology Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LIVONIA DERMATOLOGY PLLC (NPI 1457406217) is a healthcare organization registered as a dermatology in Livonia, Michigan and active in the NPI registry since January 2007. The organization holds a CLIA Certificate of Compliance certificate valid through December 21, 2027 and lists David Pegouske, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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)
Livonia Dermatology Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 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
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Livonia Dermatology PLLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
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 23D1015730
Livonia Dermatology · Livonia, MIFrequently 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 Livonia Dermatology PLLC's NPI number?
The NPI number for Livonia Dermatology PLLC is 1457406217. It was assigned to this organization in the NPPES registry on January 24, 2007.
Where is Livonia Dermatology PLLC located?
Livonia Dermatology PLLC is located at 14801 Farmington Rd, Livonia, MI 48154. The listed phone number is (734) 542-8100.
What is Livonia Dermatology PLLC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Livonia Dermatology PLLC enrolled in Medicare?
Yes. Livonia Dermatology PLLC is registered in the Medicare PECOS enrollment system.
When is Livonia Dermatology 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 (Michigan, Clinic/Group Practice) is due for revalidation by December 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 Livonia Dermatology PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Livonia Dermatology PLLC, 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. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Livonia Dermatology PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 23D1015730) is associated with this NPI, valid through December 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Livonia Dermatology PLLC accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Livonia Dermatology 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 Livonia Dermatology PLLC was last updated on December 6, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.
# Livonia Dermatology Pllc · NPI 1457406217
Dermatology organization in Livonia, Michigan. Organization record, active in the CMS NPPES registry since January 24, 2007.
## Identity
- **NPI:** 1457406217 (Entity type: Organization)
- **Enumerated:** January 24, 2007
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** David Pegouske, OWNER
## Practice location
- **Address:** 14801 FARMINGTON RD, Livonia, MI 48154-5429
- **Phone:** (734) 542-8100 · **Fax:** (734) 542-8168
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Michigan, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (2), Nurse Practitioner (1); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 6, 2011
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1457406217) · Data from the CMS NPPES public registry.