MOUNTAIN WEST DERM - BLACKHART PLLC
NPI 1619517539
Clinic/Center - Ambulatory Surgical in Spokane Valley, WA
NPI Status: Active since January 08, 2020
Contact Information
1807 N HUTCHINSON RD
SPOKANE VALLEY, WA
ZIP 99212
Phone: (509) 456-7414
Fax: (509) 624-0764
- Organization
- Clinic/Center
- Ambulatory Surgical
- Accepts Insurance
- CLIA Number: 13D2032958
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 03-25-2027
About MOUNTAIN WEST DERM - BLACKHART PLLC
This page provides the complete NPI Profile along with additional information for Mountain West Derm - Blackhart Pllc, a provider established in Spokane Valley, Washington operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1619517539 assigned on January 2020. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Bret S Blackhart Md (Owner)
- NPI
- 1619517539
- Provider Name
- MOUNTAIN WEST DERM - BLACKHART PLLC
- Entity Type
- Organization
- Location Address
- 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212
- Location Phone
- (509) 456-7414
- Location Fax
- (509) 624-0764
- Mailing Address
- 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212
- Mailing Phone
- (509) 456-7414
- Mailing Fax
- (509) 624-0764
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-08-2020
- Last Update Date
- 01-08-2020
- Code Navigator
Location Map
Secondary Locations
- 1700 W Riverstone Dr
Coeur D Alene, ID 83814
(208) 770-2822
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Premera Blue Cross Alaska One Gold - PPO
- Premera Blue Cross Preferred Bronze 5800 HSA - PPO
- Premera Blue Cross Preferred Bronze 6350 - PPO
- Premera Blue Cross Preferred Gold 1500 - PPO
- Premera Blue Cross Preferred Silver 4500 - PPO
- Premera Blue Cross Standard Bronze II - PPO
- Premera Blue Cross Standard Gold - PPO
- Premera Blue Cross Standard Silver - PPO
- Premera Blue Cross Family Dental - PPO
- Premera Blue Cross Pediatric Dental - PPO
- HSA Qualified 7500 Bronze - Choice Network - EPO
- HSA-E Qualified 7500 Bronze - Signature Network - EPO
- Providence Oregon Standard Bronze Plan - Choice Network - EPO
- Providence Oregon Standard Bronze Plan - Signature Network - EPO
- Providence Oregon Standard Gold Plan - Choice Network - EPO
- Providence Oregon Standard Gold Plan - Signature Network - EPO
- Providence Oregon Standard Silver Plan - Choice Network - EPO
- Providence Oregon Standard Silver Plan - Signature Network - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Full thickness skin graft to nose, ears, eyelids, or lips, 20.0 sq cm or less
Partial thickness self skin graft to face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less
Repair of wound by transferring skin, 30.1-60.0 sq cm
Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less
Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm
Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less
Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm
Repair of wound of scalp, arms, or legs by transferring skin, 10.1-30.0 sq cm
A full thickness skin graft is a procedure where a layer of skin is taken from one area of the body and transplanted to another. If it's done on the nose, ears, eyelids, or lips, it helps restore these areas when damaged. The size of the graft is 20.0 sq cm or less.
This service was performed 109 times for 106 patientsA partial thickness self skin graft involves taking a thin layer of skin from a healthy part of your body and transplanting it to a damaged area. This procedure is used for areas such as the face, scalp, eyelids, mouth, neck, ears, hands, feet, fingers, or toes. It covers up to 100.0 sq cm or 1% body area for infants and children.
This service was performed 72 times for 70 patientsThis procedure involves repairing a wound by moving healthy skin from one area of the body to the wound site. The transferred skin, measuring between 30.1-60.0 square cm, aids in healing and reduces scarring.
This service was performed 101 times for 98 patientsThis procedure involves repairing a wound on the eyelids, nose, ears, or lips by moving a small piece of skin (10.0 sq cm or less) from one area to another. The goal is to heal the wound and restore the function and appearance of the affected area.
This service was performed 107 times for 105 patientsThis procedure involves repairing a wound on the eyelids, nose, ears, or lips by transferring skin from another part of the body. The size of the skin transferred will be between 10.1 to 30.0 square centimeters. It is performed to restore function and appearance.
This service was performed 66 times for 65 patientsThis procedure involves repairing a wound on various body parts by transferring skin from another area. The transferred skin, up to 10.0 sq cm, helps to cover the wound, promoting healing and reducing scarring. It's a common method for treating larger or deeper wounds.
This service was performed 85 times for 85 patientsThis procedure involves repairing a wound on specified body areas by transferring skin from another part of the body. The transferred skin, measuring between 10.1 to 30.0 square cm, aids in healing the wound and restoring the skin's normal function.
This service was performed 163 times for 158 patientsThis procedure involves repairing a wound on your scalp, arm, or leg by moving skin from another part of your body. The skin transferred will cover an area between 10.1 to 30.0 square cm. This helps promote healing and reduce scarring.
This service was performed 73 times for 69 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D2032958
- Facility Type
- Physician Office
- Certificate Effective Date
- March 26, 2025
- Certificate Expiration Date
- March 25, 2027
- Laboratory Director
- DR. CHAD SUKUT
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Mountain West Derm - Blackhart Pllc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1619517539, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 18 providers are registered at the same or a nearby location.
SPOKANE VALLEY, WA 99212
SPOKANE VALLEY, WA 99212
SPOKANE VALLEY, WA 99212
SPOKANE VALLEY, WA 99212
SPOKANE VALLEY, WA 99212
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1619517539, enumerated as an "organization" on January 08, 2020.
The provider is located at 1807 N HUTCHINSON RD SPOKANE VALLEY, WA 99212 and the phone number is (509) 456-7414.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: Premera Blue Cross Blue Shield of Alaska and. Please consult your insurance carrier or call the provider to verify.
