MOUNTAIN PINE DERMATOLOGY, PLLC
NPI 1659827665
Dermatology in Meridian, ID

Active since August 30, 2016CLIA Certified · 4 labs
4664 N PENNGROVE WAY STE 100, MERIDIAN, ID 83646(208) 898-7467 Get Directions Write a Review

NPPES record last updated: July 5, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 5, 2020, Aug 30, 2016 (2 updates tracked since 2016).

About Mountain Pine Dermatology, Pllc NPPES

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

MOUNTAIN PINE DERMATOLOGY, PLLC (NPI 1659827665) is a healthcare organization registered as a dermatology in Meridian, Idaho and active in the NPI registry since August 2016. The organization holds 4 active CLIA laboratory certificates and lists Richard Scott Thomas, Owner, as its authorized official.

NPPES Registry Identity

NPI1659827665
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMOUNTAIN PINE DERMATOLOGY, PLLC
Location Address4664 N PENNGROVE WAY STE 100Meridian, ID 83646-7442
Mailing Address4664 N Penngrove Way Ste 100Meridian, ID 83646-7442 · (208) 898-7467
Organization SubpartNo
Authorized OfficialRichard Scott ThomasOwner · (208) 250-7433
Enumeration DateAugust 30, 2016
Last NPPES UpdateJuly 5, 20202 updates tracked since enumeration
NPPES CertifiedJuly 5, 2020
NPI 1659827665 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in ID · O-0934
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.

4664 N PENNGROVE WAY STE 100, Meridian, ID 83646

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

CLIA Laboratory Certificates CMS CLIA 4

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 13D2120213

Mountain Pine Dermatology · Meridian, ID
Active · expires Nov 27, 2026
CLIA Number13D2120213
Laboratory TypePhysician Office
Certificate Effective DateNovember 28, 2024
Certificate Expiration DateNovember 27, 2026
Laboratory DirectorRichard S. Thomas
Laboratory Phone(208) 898-7467
Laboratory LocationMountain Pine Dermatology4664 N Penngrove Way Ste 100, Meridian, ID 83646
CLIA data matches this NPI record on: Address 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.

Certificate of Waiver 38D2179965

Mountain Pine Dermatology, PLLC · Baker City, OR
Active · expires Feb 10, 2028
CLIA Number38D2179965
Laboratory TypePhysician Office
Certificate Effective DateFebruary 11, 2026
Certificate Expiration DateFebruary 10, 2028
Laboratory DirectorRichard S. Thomas
Laboratory Phone(208) 898-7467
Laboratory LocationMountain Pine Dermatology, PLLC3175 Pocahontas Rd, Baker City, OR 97814
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Compliance 13D2167724

Mountain Pine Dermatology · Caldwell, ID
Active · expires Nov 17, 2026
CLIA Number13D2167724
Laboratory TypePhysician Office
Certificate Effective DateNovember 18, 2024
Certificate Expiration DateNovember 17, 2026
Laboratory DirectorRichard S. Thomas
Laboratory Phone(208) 898-7467
Laboratory LocationMountain Pine Dermatology211 E Logan St Ste 305, Caldwell, ID 83605
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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 13D2155363

Mountain Pine Dermatology · Mountain Home, ID
Active · expires Sep 26, 2026
CLIA Number13D2155363
Laboratory TypePhysician Office
Certificate Effective DateSeptember 27, 2024
Certificate Expiration DateSeptember 26, 2026
Laboratory DirectorRichard S. Thomas
Laboratory Phone(208) 898-7467
Laboratory LocationMountain Pine Dermatology110 Rattlesnake St Ste B, Mountain Home, ID 83647
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
4664 N PENNGROVE WAY STE 100
MERIDIAN, ID 83646
Nurse Practitioner (Family)
4664 N PENNGROVE WAY STE 100
MERIDIAN, ID 83646
Dermatology
4664 N PENNGROVE WAY STE 100
MERIDIAN, ID 83646
Dermatology
4664 N PENNGROVE WAY STE 100
MERIDIAN, ID 83646
Nurse Practitioner (Family)
4664 N PENNGROVE WAY STE 100
MERIDIAN, ID 83646
Dermatology
4664 N PENNGROVE WAY STE 100
MERIDIAN, ID 83646
Nurse Practitioner (Family)
4664 N PENNGROVE WAY STE 100
MERIDIAN, ID 83646

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 Pine Dermatology, PLLC's NPI number?

The NPI number for Mountain Pine Dermatology, PLLC is 1659827665. It was assigned to this organization in the NPPES registry on August 30, 2016.

Where is Mountain Pine Dermatology, PLLC located?

Mountain Pine Dermatology, PLLC is located at 4664 N Penngrove Way Ste 100, Meridian, ID 83646. The listed phone number is (208) 898-7467.

What is Mountain Pine Dermatology, PLLC's specialty?

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

Does Mountain Pine Dermatology, PLLC hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Mountain Pine Dermatology, PLLC accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc., Providence Health Plan and Regence BlueCross BlueShield of Oregon list Mountain Pine Dermatology, 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 Pine Dermatology, PLLC was last updated on July 5, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.