Blue Valley Dermatology LLC
NPI 1104354794 · Dermatology Physician · Overland Park, KS
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Blue Valley Dermatology LLC is a Dermatology Physician organization in Overland Park, KS (NPI 1104354794).
Provider details
- NPI number
- 1104354794
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Tom Tkachuk, Manager(415) 802-1310
- License
- 04-36968 (KS)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (1)
- 7520 W 160th St Ste 100Overland Park, KS 66085-8137Phone: (913) 871-8221Fax: (913) 495-5456
Registry dates
- Enumerated
- 2017-05-26
- Last updated
- 2021-10-25
- Certified
- 2021-10-25
Frequently asked questions
- What is Blue Valley Dermatology LLC's NPI number?
- Blue Valley Dermatology LLC's National Provider Identifier (NPI) is 1104354794, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Blue Valley Dermatology LLC?
- Blue Valley Dermatology LLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Blue Valley Dermatology LLC located?
- Blue Valley Dermatology LLC's practice location on file with NPPES is 7840 W 165th Street, Overland Park, KS 66223.
- What is Blue Valley Dermatology LLC's phone number?
- The practice phone number listed in the NPPES registry for Blue Valley Dermatology LLC is (415) 802-1310.
- Does Blue Valley Dermatology LLC accept Medicare?
- Blue Valley Dermatology LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Blue Valley Dermatology LLC?
- The authorized official listed on Blue Valley Dermatology LLC's NPPES record is Tom Tkachuk, Manager. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Blue Valley Dermatology LLC's NPI active?
- Yes — Blue Valley Dermatology LLC's NPI (1104354794) is active in the NPPES registry as of the last update on 2021-10-25.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.