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DERMATOLOGY BY SHELLY
NPI 1720855141
Dermatology in Chino Valley, AZ

Active since December 06, 2023CLIA 03D2301498 · Waiver
1598 SUSAN A WILLIAMS WAY, SUITE E, CHINO VALLEY, AZ 86323(928) 499-2915(877) 406-3180 Get Directions Write a Review

NPPES record last updated: July 18, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 18, 2024, Dec 7, 2023 (2 updates tracked since 2023).

About Dermatology By Shelly NPPES

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

DERMATOLOGY BY SHELLY (NPI 1720855141) is a healthcare organization registered as a dermatology in Chino Valley, Arizona and active in the NPI registry since December 2023. The organization holds a CLIA Waiver certificate valid through March 25, 2028 and lists Shelly Lynn Crossman, Provider/owner, as its authorized official.

NPPES Registry Identity

NPI1720855141
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameDERMATOLOGY & SKIN CARE BY SHELLY
Location Address1598 SUSAN A WILLIAMS WAY, SUITE EChino Valley, AZ 86323-5957
Mailing AddressPmb Po Box 416, 1042 Willow Creek Rd Suite A101Prescott, AZ 86301 · (928) 899-4455
Phone(928) 499-2915
Fax(877) 406-3180
Organization SubpartNo
Authorized OfficialShelly Lynn CrossmanProvider/owner · (928) 499-2915
Enumeration DateDecember 6, 2023
Last NPPES UpdateJuly 18, 20242 updates tracked since enumeration
NPPES CertifiedJune 17, 2024
✔ NPI 1720855141 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
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.
1598 SUSAN A WILLIAMS WAY, Chino Valley, AZ 86323
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Other Names 2

Doing Business AsDermatology By Shelly
Doing Business AsDermatology & Skin Care By Shelly

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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dermatology By Shelly 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 Dermatology By Shelly, which bills Medicare for the services this clinician delivers.

Clinician (1)

Shelly Crossman, MSN, FNP-C
Nurse Practitioner
NPI 1295167484
448 N STATE ROUTE 89 STE H
Chino Valley, AZ 86323
(928) 499-2915
✔ PECOS✔ Accepts Medicare1.3 mi

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 Waiver 03D2301498

Dermatology And Skin Care By Shelly · Chino Valley, AZ
Active · expires Mar 25, 2028
CLIA Number03D2301498
Laboratory TypePhysician Office
Certificate Effective DateMarch 26, 2026
Certificate Expiration DateMarch 25, 2028
Laboratory DirectorShelly Crossman
Laboratory Phone(928) 499-2915
Laboratory LocationDermatology And Skin Care By Shelly448 Az-89 Ste H, Chino Valley, AZ 86323
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Dermatology & Skin Care By Shelly's NPI number?

The NPI number for Dermatology & Skin Care By Shelly is 1720855141. It was assigned to this organization in the NPPES registry on December 6, 2023. The provider is doing business as Dermatology By Shelly.

Where is Dermatology & Skin Care By Shelly located?

Dermatology & Skin Care By Shelly is located at 1598 Susan A Williams Way Suite E, Chino Valley, AZ 86323. The listed phone number is (928) 499-2915.

What is Dermatology & Skin Care By Shelly's specialty?

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

Is Dermatology & Skin Care By Shelly enrolled in Medicare?

Yes. Dermatology & Skin Care By Shelly is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dermatology & Skin Care By Shelly?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Dermatology & Skin Care By Shelly. 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.

Does Dermatology & Skin Care By Shelly hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2301498) is associated with this NPI, valid through March 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dermatology & Skin Care By Shelly was last updated on July 18, 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.