Eagle Dermatology, PLLC
NPI 1417456385 · Dermatology Physician · Eagle, ID
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Eagle Dermatology, PLLC is a Dermatology Physician organization in Eagle, ID (NPI 1417456385).
Provider details
- NPI number
- 1417456385
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jennifer Guerrero, Practice Manager(208) 391-7210
- License
- O-1094 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Procedural Dermatology Physician207NS0135X
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
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
Registry dates
- Enumerated
- 2018-02-06
- Last updated
- 2018-02-06
Frequently asked questions
- What is Eagle Dermatology, PLLC's NPI number?
- Eagle Dermatology, PLLC's National Provider Identifier (NPI) is 1417456385, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Eagle Dermatology, PLLC?
- Eagle Dermatology, PLLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Eagle Dermatology, PLLC located?
- Eagle Dermatology, PLLC's practice location on file with NPPES is 323 E Riverside Dr Ste 234, Eagle, ID 83616-6865.
- What is Eagle Dermatology, PLLC's phone number?
- The practice phone number listed in the NPPES registry for Eagle Dermatology, PLLC is (208) 391-7210.
- Does Eagle Dermatology, PLLC accept Medicare?
- Eagle Dermatology, PLLC 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 Eagle Dermatology, PLLC?
- The authorized official listed on Eagle Dermatology, PLLC's NPPES record is Jennifer Guerrero, Practice Manager. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Eagle Dermatology, PLLC's NPI active?
- Yes — Eagle Dermatology, PLLC's NPI (1417456385) is active in the NPPES registry as of the last update on 2018-02-06.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.