LAKE OSWEGO DERMATOLOGY GROUP, PC
NPI 1710167689
Dermatology in Lake Oswego, OR
About Lake Oswego Dermatology Group, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE OSWEGO DERMATOLOGY GROUP, PC (NPI 1710167689) is a healthcare organization registered as a dermatology in Lake Oswego, Oregon and active in the NPI registry since November 2007. The organization holds a CLIA Certificate of Compliance certificate valid through November 28, 2026 and lists Rita Shigeta, Office 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)
Lake Oswego Dermatology Group, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Lake Oswego Dermatology Group, PC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.
Clinicians, nearest first (6)
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 38D0698929
Lake Oswego Dermatology Group Laboratory · Lake Oswego, ORFrequently 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 Lake Oswego Dermatology Group, PC's NPI number?
The NPI number for Lake Oswego Dermatology Group, PC is 1710167689. It was assigned to this organization in the NPPES registry on November 8, 2007.
Where is Lake Oswego Dermatology Group, PC located?
Lake Oswego Dermatology Group, PC is located at 17704 Jean Way Suite 102, Lake Oswego, OR 97035. The listed phone number is (503) 635-9221.
What is Lake Oswego Dermatology Group, PC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Lake Oswego Dermatology Group, PC enrolled in Medicare?
Yes. Lake Oswego Dermatology Group, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lake Oswego Dermatology Group, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Lake Oswego Dermatology Group, PC. 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 (4) and Radiation Oncology (2). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Lake Oswego Dermatology Group, PC hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 38D0698929) is associated with this NPI, valid through November 28, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Lake Oswego Dermatology Group, PC accept?
Health plans from BridgeSpan Health Company, Providence Health Plan and Regence BlueCross BlueShield of Oregon list Lake Oswego Dermatology Group, PC 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 Lake Oswego Dermatology Group, PC was last updated on February 3, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Lake Oswego Dermatology Group, Pc · NPI 1710167689
Dermatology organization in Lake Oswego, Oregon. Organization record, active in the CMS NPPES registry since November 8, 2007.
## Identity
- **NPI:** 1710167689 (Entity type: Organization)
- **Enumerated:** November 8, 2007
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Rita Shigeta, OFFICE MANAGER
## Practice location
- **Address:** 17704 JEAN WAY, SUITE 102, Lake Oswego, OR 97035-5497
- **Phone:** (503) 635-9221 · **Fax:** (503) 635-5902
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 6 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (4), Radiation Oncology (2); 3 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 3, 2010
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1710167689) · Data from the CMS NPPES public registry.