ADA DERMATOLOGY, P.A.
NPI 1952483299
Dermatology - Procedural Dermatology in Boise, ID
About Ada Dermatology, P.a. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ADA DERMATOLOGY, P.A. (NPI 1952483299) is a healthcare organization registered as a procedural dermatology in Boise, Idaho and active in the NPI registry since October 2006. The organization holds a CLIA Microscopy certificate valid through December 10, 2027 and lists Richard Dale Blickenstaff, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ada Dermatology, P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Ada Dermatology, P.A., which bills Medicare for the services this clinician delivers.
Clinician (1)
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 for Provider-Performed Microscopy Procedures (PPMP) 13D0521684
Ada Dermatology Clinic · Boise, IDFrequently 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 Ada Dermatology, P.A.'s NPI number?
The NPI number for Ada Dermatology, P.A. is 1952483299. It was assigned to this organization in the NPPES registry on October 19, 2006.
Where is Ada Dermatology, P.A. located?
Ada Dermatology, P.A. is located at 6454 W Emerald Street, Boise, ID 83704. The listed phone number is (208) 377-0820.
What is Ada Dermatology, P.A.'s specialty?
The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.
Is Ada Dermatology, P.A. enrolled in Medicare?
Yes. Ada Dermatology, P.A. is registered in the Medicare PECOS enrollment system.
When is Ada Dermatology, P.A.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Idaho, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Ada Dermatology, P.A.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Ada Dermatology, P.A.. 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 Ada Dermatology, P.A. hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 13D0521684) is associated with this NPI, valid through December 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Ada Dermatology, P.A. accept?
Health plans from Moda Health Plan, Inc. list Ada Dermatology, P.A. 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 Ada Dermatology, P.A. was last updated on January 30, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.
# Ada Dermatology, P.a. · NPI 1952483299
Procedural Dermatology organization in Boise, Idaho. Organization record, active in the CMS NPPES registry since October 19, 2006.
## Identity
- **NPI:** 1952483299 (Entity type: Organization)
- **Enumerated:** October 19, 2006
- **Primary specialty:** Dermatology - Procedural Dermatology · taxonomy 207NS0135X
- **Organization subpart:** No
- **Authorized official:** Richard Blickenstaff, PRESIDENT
## Practice location
- **Address:** 6454 W EMERALD STREET, Boise, ID 83704-8734
- **Phone:** (208) 377-0820
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, Idaho, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Dermatology) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 30, 2012
- **Other identifiers:** Medicaid 002639100 (ID); Medicare PIN 1120397 (ID)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1952483299) · Data from the CMS NPPES public registry.