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MOUNTAIN WEST DERM - BLACKHART PLLC
NPI 1619517539
Clinic/Center - Ambulatory Surgical in Spokane Valley, WA

Active since January 08, 2020
1807 N HUTCHINSON RD, SPOKANE VALLEY, WA 99212(509) 456-7414(509) 624-0764 Get Directions Write a Review

NPPES record last updated: January 8, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mountain West Derm - Blackhart Pllc NPPES

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

MOUNTAIN WEST DERM - BLACKHART PLLC (NPI 1619517539), doing business as Advanced Dermatology & Skin Surgery, is a healthcare organization registered as an ambulatory surgical in Spokane Valley, Washington and active in the NPI registry since January 2020. The organization maintains a secondary practice location in Coeur D Alene and lists Bret S Blackhart, Owner, as its authorized official.

NPPES Registry Identity

NPI1619517539
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameMOUNTAIN WEST DERM - BLACKHART PLLC
Location Address1807 N HUTCHINSON RDSpokane Valley, WA 99212-2444
Mailing Address1807 N Hutchinson RdSpokane Valley, WA 99212-2444 · (509) 456-7414 · Fax (509) 624-0764
Phone(509) 456-7414
Fax(509) 624-0764
Organization SubpartNo
Authorized OfficialBret S BlackhartOwner · (775) 336-3624
Enumeration DateJanuary 8, 2020
✔ NPI 1619517539 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
1807 N HUTCHINSON RD, Spokane Valley, WA 99212
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Other Names 1

Doing Business AsAdvanced Dermatology & Skin Surgery

Secondary Practice Location 1

Location 11700 W Riverstone DrCoeur D Alene, ID 83814-5683 · Phone (208) 770-2822 · Fax (208) 770-2911

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska, Providence Health Plan.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)

Mountain West Derm - Blackhart Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

9

Medicare enrollment records show 9 clinicians reassign Medicare billing to Mountain West Derm - Blackhart PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 6 within 10 miles. They are listed nearest first.

Clinicians, nearest first (9)

Robin Hornung, MD
Dermatology
NPI 1437230786
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts MedicareSame address
Chadd Sukut, MD
Dermatology
NPI 1467673061
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts MedicareSame address
Joseph Cvancara, M.D.
Dermatology
NPI 1548235450
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare0.2 mi
James Parker, MD
Dermatology
NPI 1144789405
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS✔ Accepts Medicare0.2 mi
Joel Sears, M.D.
Dermatology
NPI 1184699365
1807 N HUTCHINSON RD
Spokane Valley, WA 99212
(509) 456-7414
✔ PECOS0.2 mi
Danielle Wolff, MD
Emergency Medicine
NPI 1295751097
800 W 5TH AVE
Spokane, WA 99204
(509) 458-5800
✔ PECOS6.7 mi
Courtney Gwinn, M.D.
Dermatology
NPI 1508210741
1959 NE PACIFIC ST ROOM BB-527
Seattle, WA 98195
(206) 543-3605
✔ PECOS✔ Accepts Medicare234 mi
Michael Heaphy, M.D.
Dermatology
NPI 1174620496
4814 SPARKS BLVD
Sparks, NV 89436
(775) 324-0699
✔ PECOS✔ Accepts Medicare572 mi
Lindsey Goddard, M.D.
Dermatology
NPI 1639565872
510 N 17TH AVE STE C
Wausau, WI 54401
(715) 849-5333
✔ PECOS✔ Accepts Medicare1,328 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Full thickness skin graft to nose, ears, eyelids, or lips, 20.0 sq cm or less 15260
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.
192 services187 patients
Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm 14041
This 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.
111 services108 patients
Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less 14060
This 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.
84 services83 patients
Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less 14040
This 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.
63 services63 patients
Repair of wound by transferring skin, 30.1-60.0 sq cm 14301
This 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.
62 services61 patients
Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm 14061
This 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.
56 services55 patients

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 1619517539. It was assigned to this organization in the NPPES registry on January 8, 2020. The provider is doing business as Advanced Dermatology & Skin Surgery.

Where is Mountain West Derm - Blackhart PLLC located?

Mountain West Derm - Blackhart PLLC is located at 1807 N Hutchinson Rd, Spokane Valley, WA 99212. The listed phone number is (509) 456-7414.

What is Mountain West Derm - Blackhart PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

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), 9 clinicians in 2 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 (8) and Emergency Medicine (1). Of these, 2 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Mountain West Derm - Blackhart PLLC accept?

Health plans from PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska and Providence Health Plan 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 January 8, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.