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PREMIER DERMATOLOGY, LTD.
NPI 1467898007
Dermatology in Waterloo, IA

Active since May 21, 2013CLIA 16D2057256 · Certificate of Compliance
3741 PHEASANT LN, WATERLOO, IA 50701(319) 234-6000(319) 234-6001 Get Directions Write a Review

NPPES record last updated: February 1, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Premier Dermatology, Ltd. NPPES

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

PREMIER DERMATOLOGY, LTD. (NPI 1467898007) is a healthcare organization registered as a dermatology in Waterloo, Iowa and active in the NPI registry since May 2013. The organization holds a CLIA Certificate of Compliance certificate valid through December 16, 2027, maintains a secondary practice location in Waverly, and lists Justin C Ellerbroek, Owner, as its authorized official.

NPPES Registry Identity

NPI1467898007
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePREMIER DERMATOLOGY, LTD.
Location Address3741 PHEASANT LNWaterloo, IA 50701-5215
Mailing AddressPo Box 2400Waterloo, IA 50704-2400 · (319) 234-6000 · Fax (319) 234-6001
Phone(319) 234-6000
Fax(319) 234-6001
Organization SubpartNo
Authorized OfficialJustin C EllerbroekOwner · (319) 233-3044
Enumeration DateMay 21, 2013
Last NPPES UpdateFebruary 1, 2024
NPPES CertifiedFebruary 1, 2024
✔ NPI 1467898007 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.
3741 PHEASANT LN, Waterloo, IA 50701
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Secondary Practice Location 1

Location 1312 9th St SW Ste 2000Waverly, IA 50677-2909 · Phone (319) 234-6000 · Fax (319) 234-6001

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Premier Dermatology, Ltd., which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Alena Ellerbroek, MSN,FNP
Nurse Practitioner
NPI 1376858654
3741 PHEASANT LN
Waterloo, IA 50701
(319) 234-6000
✔ PECOS✔ Accepts MedicareSame address
Justin Ellerbroek, M.D.
Dermatology
NPI 1790981207
3741 PHEASANT LN
Waterloo, IA 50701
(319) 234-6000
✔ PECOS✔ Accepts MedicareSame address

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 16D2057256

Premier Dermatology, Ltd · Waterloo, IA
Active · expires Dec 16, 2027
CLIA Number16D2057256
Laboratory TypePhysician Office
Certificate Effective DateDecember 17, 2025
Certificate Expiration DateDecember 16, 2027
Laboratory DirectorJustin C. Ellerbroek
Laboratory Phone(319) 234-6000
Laboratory LocationPremier Dermatology, Ltd3741 Pheasant Lane, Waterloo, IA 50701
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.

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 Premier Dermatology, Ltd.'s NPI number?

The NPI number for Premier Dermatology, Ltd. is 1467898007. It was assigned to this organization in the NPPES registry on May 21, 2013.

Where is Premier Dermatology, Ltd. located?

Premier Dermatology, Ltd. is located at 3741 Pheasant Ln, Waterloo, IA 50701. The listed phone number is (319) 234-6000.

What is Premier Dermatology, Ltd.'s specialty?

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

Is Premier Dermatology, Ltd. enrolled in Medicare?

Yes. Premier Dermatology, Ltd. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Premier Dermatology, Ltd.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Premier Dermatology, Ltd., 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Premier Dermatology, Ltd. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 16D2057256) is associated with this NPI, valid through December 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Premier Dermatology, Ltd. was last updated on February 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.