1. Home
  2. Directory
  3. Utah
  4. West Jordan
  5. Dermatology
  6. NPI Profile

JORDAN VALLEY DERMATOLOGY CENTER LLC
NPI 1558766477
Dermatology in West Jordan, UT

Active since November 04, 2014CLIA 46D0685802 · Certificate of Compliance
3570 W 9000 S, WEST JORDAN, UT 84088(801) 569-1456(801) 565-7931 Get Directions Write a Review

NPPES record last updated: November 4, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jordan Valley Dermatology Center Llc NPPES

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

JORDAN VALLEY DERMATOLOGY CENTER LLC (NPI 1558766477) is a healthcare organization registered as a dermatology in West Jordan, Utah and active in the NPI registry since November 2014. The organization holds a CLIA Certificate of Compliance certificate valid through December 7, 2027 and lists Wesley R Brown, Owner, as its authorized official.

NPPES Registry Identity

NPI1558766477
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameJORDAN VALLEY DERMATOLOGY CENTER LLC
Location Address3570 W 9000 SWest Jordan, UT 84088-8869
Mailing Address3570 W 9000 SWest Jordan, UT 84088-8869 · (801) 569-1456 · Fax (801) 565-7931
Phone(801) 569-1456
Fax(801) 565-7931
Organization SubpartNo
Authorized OfficialWesley R BrownOwner · (801) 569-1456
Enumeration DateNovember 4, 2014
✔ NPI 1558766477 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in UT · 1756931205
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.
3570 W 9000 S, West Jordan, UT 84088
Open in Google Maps ↗

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

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Regence BlueCross BlueShield of Utah.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)

Jordan Valley Dermatology Center Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Jordan Valley Dermatology Center LLC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Mckenna Smith, FNP-C, DNP, APRN
Nurse Practitioner
NPI 1811739907
10654 S RIVER HEIGHTS DR STE 210
South Jordan, UT 84095
(801) 335-6728
✔ PECOS✔ Accepts Medicare2.1 mi
Douglass Forsha, MD
Dermatology
NPI 1285674671
10654 SOUTH RIVER HEIGHTS DRIVE SUITE 210
South Jordan, UT 84095
(801) 569-1456
✔ PECOS✔ Accepts Medicare2.1 mi
Shawna Heaps, FNP
Nurse Practitioner
NPI 1982252318
10654 S RIVER HEIGHTS DR STE 210
South Jordan, UT 84095
(801) 569-1456
✔ PECOS✔ Accepts Medicare2.1 mi
Hu Ding, MD
Pathology
NPI 1710923552
630 MEDICAL DR
Bountiful, UT 84010
(801) 299-2200
✔ PECOS✔ Accepts Medicare21 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 46D0685802

Jordan Valley Dermatology Center · South Jordan, UT
Active · expires Dec 7, 2027
CLIA Number46D0685802
Laboratory TypePhysician Office
Certificate Effective DateDecember 8, 2025
Certificate Expiration DateDecember 7, 2027
Laboratory DirectorHu Ding
Laboratory Phone(801) 569-1456
Laboratory LocationJordan Valley Dermatology Center10654 S River Heights Drive, Suite 210, South Jordan, UT 84095
CLIA data matches this NPI record on: 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 Jordan Valley Dermatology Center LLC's NPI number?

The NPI number for Jordan Valley Dermatology Center LLC is 1558766477. It was assigned to this organization in the NPPES registry on November 4, 2014.

Where is Jordan Valley Dermatology Center LLC located?

Jordan Valley Dermatology Center LLC is located at 3570 W 9000 S, West Jordan, UT 84088. The listed phone number is (801) 569-1456.

What is Jordan Valley Dermatology Center LLC's specialty?

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

Is Jordan Valley Dermatology Center LLC enrolled in Medicare?

Yes. Jordan Valley Dermatology Center LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jordan Valley Dermatology Center LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Jordan Valley Dermatology Center LLC, in Dermatology, Nurse Practitioner and Pathology. 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 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Jordan Valley Dermatology Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 46D0685802) is associated with this NPI, valid through December 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Jordan Valley Dermatology Center LLC accept?

Health plans from BridgeSpan Health Company, Molina Healthcare and Regence BlueCross BlueShield of Utah list Jordan Valley Dermatology Center 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 Jordan Valley Dermatology Center LLC was last updated on November 4, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.