LAKESHORE DERM & LASER CENTER PLC
NPI 1538209945
Dermatology - Procedural Dermatology in Norton Shores, MI
About Lakeshore Derm & Laser Center Plc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKESHORE DERM & LASER CENTER PLC (NPI 1538209945) is a healthcare organization registered as a procedural dermatology in Norton Shores, Michigan and active in the NPI registry since February 2007. The organization lists Jason Barrett Van Ittersum, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
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)
Lakeshore Derm & Laser Center Plc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 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
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Lakeshore Derm & Laser Center Plc, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians, nearest first (7)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Lakeshore Derm & Laser Center Plc's NPI number?
The NPI number for Lakeshore Derm & Laser Center Plc is 1538209945. It was assigned to this organization in the NPPES registry on February 7, 2007.
Where is Lakeshore Derm & Laser Center Plc located?
Lakeshore Derm & Laser Center Plc is located at 6225 Prairie St, Norton Shores, MI 49444. The listed phone number is (231) 798-9500.
What is Lakeshore Derm & Laser Center Plc's specialty?
The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.
Is Lakeshore Derm & Laser Center Plc enrolled in Medicare?
Yes. Lakeshore Derm & Laser Center Plc is registered in the Medicare PECOS enrollment system.
When is Lakeshore Derm & Laser Center Plc'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 November 30, 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 Lakeshore Derm & Laser Center Plc?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Lakeshore Derm & Laser Center Plc. 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 (6) and Family Practice (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.
What insurance does Lakeshore Derm & Laser Center Plc accept?
Health plans from Blue Care Network of Michigan list Lakeshore Derm & Laser Center Plc 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 Lakeshore Derm & Laser Center Plc was last updated on October 22, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.
# Lakeshore Derm & Laser Center Plc · NPI 1538209945
Procedural Dermatology organization in Norton Shores, Michigan. Organization record, active in the CMS NPPES registry since February 7, 2007.
## Identity
- **NPI:** 1538209945 (Entity type: Organization)
- **Enumerated:** February 7, 2007
- **Primary specialty:** Dermatology - Procedural Dermatology · taxonomy 207NS0135X
- **Organization subpart:** No
- **Authorized official:** Jason Van Ittersum, OWNER
## Practice location
- **Address:** 6225 PRAIRIE ST, Norton Shores, MI 49444-7831
- **Phone:** (231) 798-9500 · **Fax:** (231) 798-9533
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Michigan, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 7 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (6), Family Practice (1); 4 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 22, 2013
- **Other identifiers:** Medicare ID-Type Unspecified 0P29750 (MI)
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Source: [NPI Profile](https://npiprofile.com/npi/1538209945) · Data from the CMS NPPES public registry.