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CLINIC FOR DERMATOLOGY & WELLNESS LLC
NPI 1467908863
Nurse Practitioner - Family in Medford, OR

Active since August 26, 2016CLIA 38D2124889 · Certificate of Compliance
2924 SISKIYOU BLVD STE 200, MEDFORD, OR 97504(541) 200-2793 Get Directions Write a Review

NPPES record last updated: June 19, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 19, 2021, Nov 16, 2017, Sep 20, 2016 and 2 more (5 updates tracked since 2016).

About Clinic For Dermatology & Wellness Llc NPPES

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

CLINIC FOR DERMATOLOGY & WELLNESS LLC (NPI 1467908863) is a healthcare organization registered as a family in Medford, Oregon and active in the NPI registry since August 2016. The organization holds a CLIA Certificate of Compliance certificate valid through January 6, 2028, maintains a secondary practice location in Medford, and lists Joseph John Atzenbeck, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1467908863
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameCLINIC FOR DERMATOLOGY & WELLNESS LLC
Location Address2924 SISKIYOU BLVD STE 200Medford, OR 97504-6462
Mailing Address2924 Siskiyou Blvd Ste 200Medford, OR 97504-6462 · (541) 200-2777 · Fax (541) 214-2575
Phone(541) 200-2793
Organization SubpartNo
Authorized OfficialJoseph John AtzenbeckChief Executive Officer · (541) 200-2777
Enumeration DateAugust 26, 2016
Last NPPES UpdateJune 19, 20215 updates tracked since enumeration
NPPES CertifiedJune 19, 2021
✔ NPI 1467908863 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Also ListedPhysician AssistantTaxonomy 363A00000X
2924 SISKIYOU BLVD STE 200, Medford, OR 97504
Open in Google Maps ↗

Secondary Practice Location 1

Location 12937 Siskiyou Blvd Ste 1Medford, OR 97504-8100 · Phone (541) 200-2777 · Fax (541) 214-2575

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 BridgeSpan Health Company, Moda Health Plan, Inc., Regence BlueCross BlueShield of Oregon.Insurance ›

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 38D2124889

Clinic For Dermatology & Wellness LLC, The · Medford, OR
Active · expires Jan 6, 2028
CLIA Number38D2124889
Laboratory TypePhysician Office
Certificate Effective DateJanuary 7, 2026
Certificate Expiration DateJanuary 6, 2028
Laboratory DirectorDr. Kevin Wright
Laboratory Phone(541) 200-2777
Laboratory LocationClinic For Dermatology & Wellness LLC, The2924 Siskiyou Blvd Suite 200, Medford, OR 97504
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.

Other Providers at the Same Location NPPES 4

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

LIESEL ERNST
Physician Assistant
2924 SISKIYOU BLVD STE 200
MEDFORD, OR 97504
Jackson County (541) 200-2777
MR. DAVID PAUL RICHARDSON JR. PA-C
Physician Assistant
2924 SISKIYOU BLVD STE 200
MEDFORD, OR 97504
Jackson County (541) 200-2777
NIKKI DANIELLE YING TANG M.D.
Dermatology (MOHS-Micrographic Surgery)
2924 SISKIYOU BLVD STE 200
MEDFORD, OR 97504
Jackson County (541) 200-2777
DR. ANYA ELIZABETH BANDT M.D.
Dermatology
2924 SISKIYOU BLVD STE 200
MEDFORD, OR 97504
Jackson County (541) 200-2777

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 Clinic For Dermatology & Wellness LLC's NPI number?

The NPI number for Clinic For Dermatology & Wellness LLC is 1467908863. It was assigned to this organization in the NPPES registry on August 26, 2016.

Where is Clinic For Dermatology & Wellness LLC located?

Clinic For Dermatology & Wellness LLC is located at 2924 Siskiyou Blvd Ste 200, Medford, OR 97504. The listed phone number is (541) 200-2793.

What is Clinic For Dermatology & Wellness LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Clinic For Dermatology & Wellness LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 38D2124889) is associated with this NPI, valid through January 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Clinic For Dermatology & Wellness LLC accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc. and Regence BlueCross BlueShield of Oregon list Clinic For Dermatology & Wellness LLC 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 Clinic For Dermatology & Wellness LLC was last updated on June 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.