MOUNTAIN WEST DERM - BLACKHART PLLC
NPI 1891467577
Dermatology in Roseburg, OR

Active since October 01, 2021
341 NW MEDICAL LOOP STE 110, ROSEBURG, OR 97471(541) 440-2165(541) 440-8932 Get Directions Write a Review

NPPES record last updated: October 4, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Oct 4, 2021, Oct 1, 2021 (2 updates tracked since 2021).

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

NPI1891467577
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMOUNTAIN WEST DERM - BLACKHART PLLC
Location Address341 NW MEDICAL LOOP STE 110Roseburg, OR 97471-5546
Mailing Address341 Nw Medical Loop Ste 110Roseburg, OR 97471-5546
Fax(541) 440-8932
Organization SubpartNo
Authorized OfficialJeffrey B ShackeltonOwner · (775) 283-4086
Enumeration DateOctober 1, 2021
Last NPPES UpdateOctober 4, 20212 updates tracked since enumeration
NPPES CertifiedOctober 4, 2021
✔ NPI 1891467577 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.
341 NW MEDICAL LOOP STE 110, Roseburg, OR 97471

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)

Mountain West Derm - Blackhart Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

25

Medicare 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

Dermatology20
Nurse Practitioner4
Micrographic Dermatologic Surgery (MDS)1

Nearest to this location (20)

See all 25
Dermatology
NPI 1467475137
341 MEDICAL LOOP STE 110
Roseburg, OR 97471
(541) 440-2165
✔ PECOS0.1 mi
Dermatology
NPI 1528476322
860 BELTLINE RD
Springfield, OR 97477
(541) 344-4168
✔ PECOS✔ Accepts Medicare61 mi
Nurse Practitioner
NPI 1962971796
2900 STATE ST STE 101
Medford, OR 97504
(541) 789-5761
✔ PECOS✔ Accepts Medicare70 mi
Nurse Practitioner
NPI 1972303857
1430 COMMERCIAL ST SE
Salem, OR 97302
(503) 364-5033
✔ PECOS118 mi
Dermatology
NPI 1417207283
2450 NE MARY ROSE PL STE 201
Bend, OR 97701
(541) 585-7546
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1538366240
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1427282383
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1275744971
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts Medicare120 mi
Dermatology
NPI 1285860288
2747 NE CONNERS AVE
Bend, OR 97701
(541) 382-5712
✔ PECOS✔ Accepts Medicare120 mi
Nurse Practitioner
NPI 1952528895
25117 SW PARKWAY AVE STE B
Wilsonville, OR 97070
(503) 783-7243
✔ PECOS✔ Accepts Medicare148 mi
Dermatology
NPI 1295800860
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare155 mi
Micrographic Dermatologic Surgery (MDS)
NPI 1558716944
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare155 mi
Nurse Practitioner
NPI 1639643943
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare155 mi
Dermatology
NPI 1679553218
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare155 mi
Dermatology
NPI 1164000352
10215 SW HALL BLVD
Tigard, OR 97223
(503) 245-2415
✔ PECOS✔ Accepts Medicare155 mi
Dermatology
NPI 1013142116
9900 SE SUNNYSIDE RD NW PERMANENTE PC, PHYSICIANS AND SURGEONS
Clackamas, OR 97015
(503) 571-3332
✔ PECOS✔ Accepts Medicare157 mi
Dermatology
NPI 1699090092
3303 SW BOND AVE # 16D OHSU
Portland, OR 97239
(503) 418-3376
✔ PECOS✔ Accepts Medicare160 mi
Dermatology
NPI 1578975991
3303 SW BOND AVE # 16D
Portland, OR 97239
(503) 418-3376
✔ PECOS✔ Accepts Medicare160 mi
Dermatology
NPI 1023279064
5050 NE HOYT ST SUITE 540
Portland, OR 97213
(503) 215-6600
✔ PECOS✔ Accepts Medicare162 mi
Dermatology
NPI 1174620496
4814 SPARKS BLVD
Sparks, NV 89436
(775) 324-0699
✔ PECOS✔ Accepts Medicare316 mi
See all 25 clinicians

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.