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CARSON DERMATOLOGY
NPI 1780852368
Dermatology in Carson City, NV

Active since February 15, 2008CLIA 29D0540265 · Certificate of Compliance
1100 S CARSON ST, CARSON CITY, NV 89701(775) 883-7811(775) 883-7871 Get Directions Write a Review

NPPES record last updated: January 22, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Carson Dermatology NPPES

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

CARSON DERMATOLOGY (NPI 1780852368) is a healthcare organization registered as a dermatology in Carson City, Nevada and active in the NPI registry since February 2008. The organization holds a CLIA Certificate of Compliance certificate valid through January 23, 2027 and lists David Alan Tack, President, as its authorized official.

NPPES Registry Identity

NPI1780852368
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameCLEMMENSEN, ADAMS, & TACK PSC
Location Address1100 S CARSON STCarson City, NV 89701-5232
Mailing Address1100 S Carson StCarson City, NV 89701-5232 · (775) 883-7811 · Fax (775) 883-7871
Phone(775) 883-7811
Fax(775) 883-7871
Organization SubpartNo
Authorized OfficialDavid Alan TackPresident · (775) 883-7811
Enumeration DateFebruary 15, 2008
Last NPPES UpdateJanuary 22, 2015
✔ NPI 1780852368 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ 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.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
1100 S CARSON ST, Carson City, NV 89701
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Other Names 1

Doing Business AsCarson Dermatology

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 MULTIPLE 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)

Carson Dermatology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Carson Dermatology, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

David Tack, M.D.
Dermatology
NPI 1124032990
1100 S CARSON ST
Carson City, NV 89701
(775) 883-7811
✔ PECOS✔ Accepts MedicareSame address
Emily Field, AGNP-C
Dermatology
NPI 1881479327
1505 MEDICAL PKWY
Carson City, NV 89703
(775) 883-7811
✔ PECOS✔ Accepts Medicare3.3 mi
Jane Shiu, MD
Dermatology
NPI 1073542148
3305 PLACER STREET
Redding, CA 96001
(530) 241-9199
✔ PECOS✔ Accepts Medicare171 mi
Max Gratrix, M.D.
Dermatology
NPI 1275737710
15225 SHADY GROVE RD SUITE 303
Rockville, MD 20850
(443) 351-3376
✔ PECOS✔ Accepts Medicare2,266 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 Compliance 29D0540265

Carson Dermatology · Carson City, NV
Active · expires Jan 23, 2027
CLIA Number29D0540265
Laboratory TypePhysician Office
Certificate Effective DateJanuary 24, 2025
Certificate Expiration DateJanuary 23, 2027
Laboratory DirectorAlan David Tack
Laboratory Phone(775) 883-7811
Laboratory LocationCarson Dermatology1505 Medical Pkwy, Carson City, NV 89703
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.

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 Clemmensen, Adams, & Tack Psc's NPI number?

The NPI number for Clemmensen, Adams, & Tack Psc is 1780852368. It was assigned to this organization in the NPPES registry on February 15, 2008. The provider is doing business as Carson Dermatology.

Where is Clemmensen, Adams, & Tack Psc located?

Clemmensen, Adams, & Tack Psc is located at 1100 S Carson St, Carson City, NV 89701. The listed phone number is (775) 883-7811.

What is Clemmensen, Adams, & Tack Psc's specialty?

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

Is Clemmensen, Adams, & Tack Psc enrolled in Medicare?

Yes. Clemmensen, Adams, & Tack Psc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Clemmensen, Adams, & Tack Psc?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Dermatology, reassign their Medicare billing to Clemmensen, Adams, & Tack Psc. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Clemmensen, Adams, & Tack Psc hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 29D0540265) is associated with this NPI, valid through January 23, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Clemmensen, Adams, & Tack Psc was last updated on January 22, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.