DERMATOLOGY CLINIC OF IDAHO
NPI 1548758501
Dermatology in Boise, ID

Active since April 25, 2018CLIA 13D0521865 · Certificate of Compliance
7733 W EMERALD ST, BOISE, ID 83704(208) 939-4599(208) 939-5010 Get Directions Write a Review

NPPES record last updated: April 25, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dermatology Clinic Of Idaho NPPES

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

DERMATOLOGY CLINIC OF IDAHO (NPI 1548758501) is a healthcare organization registered as a dermatology in Boise, Idaho and active in the NPI registry since April 2018. The organization holds a CLIA Certificate of Compliance certificate valid through December 4, 2026 and lists Bret S Blackhart, Owner, as its authorized official.

NPPES Registry Identity

NPI1548758501
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMOUNTAIN WEST DERM-BLACKHART, PLLC
Location Address7733 W EMERALD STBoise, ID 83704-9020
Mailing Address201 Franklin Rd Fl 3Brentwood, TN 37027-5214 · (615) 309-2636 · Fax (615) 309-2536
Fax(208) 939-5010
Organization SubpartYes
Authorized OfficialBret S BlackhartOwner · (775) 336-3624
Enumeration DateApril 25, 2018
✔ NPI 1548758501 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.
7733 W EMERALD ST, Boise, ID 83704

Other Names 1

Doing Business AsDermatology Clinic Of Idaho

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)

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

Clinicians Billing Medicare Through This Organization

20

Medicare enrollment records show 20 clinicians reassign Medicare billing to Dermatology Clinic Of Idaho, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 4

Dermatology14
Nurse Practitioner4
Emergency Medicine1
Internal Medicine1

Clinicians, nearest first (20)

Dermatology
NPI 1104870567
7733 W EMERALD ST
Boise, ID 83704
(208) 376-3220
✔ PECOSSame address
Internal Medicine
NPI 1710997200
1618 S MILLENIUM WAY STE 100
Meridian, ID 83642
(208) 884-3376
✔ PECOS✔ Accepts Medicare4.7 mi
Dermatology
NPI 1710117528
1700 W RIVERSTONE DR
Coeur D Alene, ID 83814
(208) 770-2822
✔ PECOS✔ Accepts Medicare283 mi
Nurse Practitioner
NPI 1255312989
1700 W RIVERSTONE DR
Coeur D Alene, ID 83814
(208) 770-2822
✔ PECOS✔ Accepts Medicare283 mi
Emergency Medicine
NPI 1295751097
800 W 5TH AVE
Spokane, WA 99204
(509) 458-5800
✔ PECOS284 mi
Dermatology
NPI 1548235450
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare285 mi
Dermatology
NPI 1386619294
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare285 mi
Dermatology
NPI 1407506975
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS285 mi
Nurse Practitioner
NPI 1710213558
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare285 mi
Nurse Practitioner
NPI 1184596777
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare285 mi
Dermatology
NPI 1184699365
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS285 mi
Dermatology
NPI 1194790006
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare285 mi
Dermatology
NPI 1437230786
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare285 mi
Dermatology
NPI 1467673061
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare285 mi
Dermatology
NPI 1174620496
4814 SPARKS BLVD
Sparks, NV 89436
(775) 324-0699
✔ PECOS✔ Accepts Medicare331 mi
Dermatology
NPI 1881697548
640 W MOANA LN
Reno, NV 89509
(775) 324-0699
✔ PECOS✔ Accepts Medicare338 mi
Dermatology
NPI 1699902726
640 W. MOANA LANE
Reno, NV 89509
(775) 324-0699
✔ PECOS✔ Accepts Medicare338 mi
Dermatology
NPI 1508210741
1959 NE PACIFIC ST ROOM BB-527
Seattle, WA 98195
(206) 543-3605
✔ PECOS✔ Accepts Medicare404 mi
Nurse Practitioner
NPI 1548557218
3823 172ND ST NE
Arlington, WA 98223
(360) 814-6810
✔ PECOS✔ Accepts Medicare423 mi
Dermatology
NPI 1639565872
510 N 17TH AVE STE C
Wausau, WI 54401
(715) 849-5333
✔ PECOS✔ Accepts Medicare1,318 mi

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 13D0521865

Dermatology Clinic Of Idaho · Boise, ID
Active · expires Dec 4, 2026
CLIA Number13D0521865
Laboratory TypePhysician Office
Certificate Effective DateDecember 5, 2024
Certificate Expiration DateDecember 4, 2026
Laboratory DirectorKevin Kiene
Laboratory Phone(208) 376-4265
Laboratory LocationDermatology Clinic Of Idaho7733 W Emerald St, Boise, ID 83704
CLIA data matches this NPI record on: Address Name
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 Mountain West Derm-Blackhart, PLLC's NPI number?

The NPI number for Mountain West Derm-Blackhart, PLLC is 1548758501. It was assigned to this organization in the NPPES registry on April 25, 2018. The provider is doing business as Dermatology Clinic Of Idaho.

Where is Mountain West Derm-Blackhart, PLLC located?

Mountain West Derm-Blackhart, PLLC is located at 7733 W Emerald St, Boise, ID 83704. The listed phone number is (208) 939-4599.

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), 20 clinicians in 4 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 (14), Nurse Practitioner (4) and Emergency Medicine (1). Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mountain West Derm-Blackhart, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 13D0521865) is associated with this NPI, valid through December 4, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mountain West Derm-Blackhart, PLLC accept?

Health plans from Molina Healthcare 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 April 25, 2018. 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.