DERMATOLOGY SPECIALISTS OF GRAND RAPIDS, PLLC
NPI 1821972548
Dermatology - MOHS-Micrographic Surgery in Grand Rapids, MI

Q: What is Dermatology Specialists Of Grand Rapids, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Active since August 05, 2025CLIA 23D2328889 · Certificate of Compliance

1000 EAST PARIS AVE SE STE 104, GRAND RAPIDS, MI 49546(586) 876-2345 Get Directions Write a Review

NPPES record last updated: August 5, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Dermatology Specialists Of Grand Rapids, Pllc NPPES

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

DERMATOLOGY SPECIALISTS OF GRAND RAPIDS, PLLC (NPI 1821972548) is a healthcare organization registered as a mohs-micrographic surgery in Grand Rapids, Michigan and active in the NPI registry since August 2025. The organization holds a CLIA Certificate of Compliance certificate valid through December 1, 2027 and lists Iltefat Hamzavi, M.d., as its authorized official.

NPPES Registry Identity

NPI1821972548

Entity TypeOrganization

Primary Taxonomy207ND0101X

Legal Business NameDERMATOLOGY SPECIALISTS OF GRAND RAPIDS, PLLC

Location Address1000 EAST PARIS AVE SE STE 104Grand Rapids, MI 49546-3680

Mailing Address43151 Dalcoma Dr Ste 4Clinton Township, MI 48038-6306 · (586) 876-2345

Phone(586) 876-2345

Organization SubpartNo

Authorized OfficialIltefat HamzaviM.d. · (810) 650-0995

Enumeration DateAugust 5, 2025

NPPES CertifiedAugust 5, 2025

✔ NPI 1821972548 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207ND0101X

Definition

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

1000 EAST PARIS AVE SE STE 104, Grand Rapids, MI 49546

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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

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.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)

Dermatology Specialists Of Grand Rapids, Pllc 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 Specialists Of Grand Rapids, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Michael Visconti, DO

Dermatology

NPI 1235767856

361 N CANTON CENTER RD
Canton, MI 48187

(734) 495-1506

✔ PECOS✔ Accepts Medicare115 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 23D2328889

Dermatology Specialists Of Grand Rapids PLLC · Grand Rapids, MI

Active · expires Dec 1, 2027

CLIA Number23D2328889

Laboratory TypePhysician Office

Certificate Effective DateDecember 2, 2025

Certificate Expiration DateDecember 1, 2027

Laboratory DirectorMichael Visconti

Laboratory Phone(616) 369-1600

Laboratory LocationDermatology Specialists Of Grand Rapids PLLC1000 E Paris Avenue SE Suite 104, Grand Rapids, MI 49546

CLIA data matches this NPI record on: Address Name

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 Dermatology Specialists Of Grand Rapids, PLLC's NPI number?

The NPI number for Dermatology Specialists Of Grand Rapids, PLLC is 1821972548. It was assigned to this organization in the NPPES registry on August 5, 2025.

Where is Dermatology Specialists Of Grand Rapids, PLLC located?

Dermatology Specialists Of Grand Rapids, PLLC is located at 1000 East Paris Ave SE Ste 104, Grand Rapids, MI 49546. The listed phone number is (586) 876-2345.

What is Dermatology Specialists Of Grand Rapids, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Dermatology Specialists Of Grand Rapids, PLLC enrolled in Medicare?

Yes. Dermatology Specialists Of Grand Rapids, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dermatology Specialists Of Grand Rapids, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Dermatology Specialists Of Grand Rapids, PLLC. 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 Specialists Of Grand Rapids, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 23D2328889) is associated with this NPI, valid through December 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Dermatology Specialists Of Grand Rapids, PLLC accept?

Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Dermatology Specialists Of Grand Rapids, 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 Dermatology Specialists Of Grand Rapids, PLLC was last updated on August 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.