ROLLA DERMATOLOGY LLC
NPI 1619714425
Physician Assistant - Medical in Rolla, MO
About Rolla Dermatology Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ROLLA DERMATOLOGY LLC (NPI 1619714425) is a healthcare organization registered as a medical in Rolla, Missouri and active in the NPI registry since July 2024. The organization lists Darrin Taylor, Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
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)
Rolla Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Rolla Dermatology LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Rolla Dermatology LLC's NPI number?
The NPI number for Rolla Dermatology LLC is 1619714425. It was assigned to this organization in the NPPES registry on July 9, 2024.
Where is Rolla Dermatology LLC located?
Rolla Dermatology LLC is located at 1312 E State Hwy 72, Rolla, MO 65401. The listed phone number is (573) 426-4112.
What is Rolla Dermatology LLC's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.
Is Rolla Dermatology LLC enrolled in Medicare?
Yes. Rolla Dermatology LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Rolla Dermatology LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Rolla Dermatology LLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Rolla Dermatology LLC accept?
Health plans from Anthem Blue Cross and Blue Shield list Rolla Dermatology 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 Rolla Dermatology LLC was last updated on July 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Rolla Dermatology Llc · NPI 1619714425
Medical organization in Rolla, Missouri. Organization record, active in the CMS NPPES registry since July 9, 2024.
## Identity
- **NPI:** 1619714425 (Entity type: Organization)
- **Enumerated:** July 9, 2024
- **Primary specialty:** Physician Assistant - Medical · taxonomy 363AM0700X
- **Organization subpart:** No
- **Authorized official:** Darrin Taylor, MANAGER
## Practice location
- **Address:** 1312 E STATE HWY 72, Rolla, MO 65401-3939
- **Phone:** (573) 426-4112
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 22, 2024
---
Source: [NPI Profile](https://npiprofile.com/npi/1619714425) · Data from the CMS NPPES public registry.