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ADA DERMATOLOGY, P.A.
NPI 1952483299
Dermatology - Procedural Dermatology in Boise, ID

Active since October 19, 2006CLIA 13D0521684 · Microscopy
6454 W EMERALD STREET, BOISE, ID 83704(208) 377-0820 Get Directions Write a Review

NPPES record last updated: January 30, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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

NPI1952483299
Entity TypeOrganization
Primary Taxonomy207NS0135X
Legal Business NameADA DERMATOLOGY, P.A.
Location Address6454 W EMERALD STREETBoise, ID 83704-8734
Mailing Address6454 W Emerald StreetBoise, ID 83704-8734
Phone(208) 377-0820
Organization SubpartNo
Authorized OfficialRichard Dale BlickenstaffPresident · (208) 377-0820
Enumeration DateOctober 19, 2006
Last NPPES UpdateJanuary 30, 2012
✔ NPI 1952483299 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · Procedural DermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207NS0135X
License✔ Licensed in ID · M-5274
Definition
Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).
6454 W EMERALD STREET, Boise, ID 83704
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Other Identifiers 2

Medicaid002639100ID
Medicare PIN1120397ID

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 Moda Health Plan, Inc..Insurance ›

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, ID
Active · expires Dec 10, 2027
CLIA Number13D0521684
Laboratory TypePhysician Office
Certificate Effective DateDecember 11, 2025
Certificate Expiration DateDecember 10, 2027
Laboratory DirectorRichard D. Blickenstaff
Laboratory Phone(208) 377-0820
Laboratory LocationAda Dermatology Clinic6454 W Emerald St, Boise, ID 83704
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RICHARD DALE BLICKENSTAFF M.D.
Dermatology (Procedural Dermatology)
6454 W EMERALD STREET
BOISE, ID 83704
Ada County (208) 377-0820

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 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.

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.