Snake River Dermatology, PA
NPI 1528263670 · Dermatology Physician · Fruitland, ID
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Snake River Dermatology, PA is a Dermatology Physician organization in Fruitland, ID (NPI 1528263670).
Provider details
- NPI number
- 1528263670
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Brock Andersen, Principal Officer(208) 452-5999
- License
- M3809 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 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
Other names (DBA / former)
- Former legal business name
- Gerald G. Overly, MD, PA
Registry dates
- Enumerated
- 2007-06-19
- Last updated
- 2013-02-04
Frequently asked questions
- What is Snake River Dermatology, PA's NPI number?
- Snake River Dermatology, PA's National Provider Identifier (NPI) is 1528263670, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Snake River Dermatology, PA?
- Snake River Dermatology, PA is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Snake River Dermatology, PA located?
- Snake River Dermatology, PA's practice location on file with NPPES is 1611 N Whitley Dr, Fruitland, ID 83619.
- What is Snake River Dermatology, PA's phone number?
- The practice phone number listed in the NPPES registry for Snake River Dermatology, PA is (208) 452-5999.
- Does Snake River Dermatology, PA accept Medicare?
- Snake River Dermatology, PA 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 Snake River Dermatology, PA?
- The authorized official listed on Snake River Dermatology, PA's NPPES record is Brock Andersen, Principal Officer. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Snake River Dermatology, PA's NPI active?
- Yes — Snake River Dermatology, PA's NPI (1528263670) is active in the NPPES registry as of the last update on 2013-02-04.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.