MOUNTAIN WEST DERM - BLACKHART PLLC
NPI 1891467577
Dermatology in Roseburg, OR
About Mountain West Derm - Blackhart Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MOUNTAIN WEST DERM - BLACKHART PLLC (NPI 1891467577) is a healthcare organization registered as a dermatology in Roseburg, Oregon and active in the NPI registry since October 2021. The organization lists Jeffrey B Shackelton, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mountain West Derm - Blackhart Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
25Medicare enrollment records show 25 clinicians reassign Medicare billing to Mountain West Derm - Blackhart PLLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 3
Nearest to this location (20)
See all 25Clackamas, OR 97015
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 West Derm - Blackhart PLLC's NPI number?
The NPI number for Mountain West Derm - Blackhart PLLC is 1891467577. It was assigned to this organization in the NPPES registry on October 1, 2021.
Where is Mountain West Derm - Blackhart PLLC located?
Mountain West Derm - Blackhart PLLC is located at 341 NW Medical Loop Ste 110, Roseburg, OR 97471. The listed phone number is (541) 440-2165.
What is Mountain West Derm - Blackhart PLLC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Mountain West Derm - Blackhart PLLC enrolled in Medicare?
Yes. Mountain West Derm - Blackhart PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mountain West Derm - Blackhart PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 25 clinicians in 3 Medicare specialties reassign their Medicare billing to Mountain West Derm - Blackhart 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. The largest specialties are Dermatology (20), Nurse Practitioner (4) and Micrographic Dermatologic Surgery (MDS) (1). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Mountain West Derm - Blackhart PLLC was last updated on October 4, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.