Providence Dermatology LLC
NPI 1568029957 · Dermatology Physician · Providence, UT
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Providence Dermatology LLC is a Dermatology Physician organization in Providence, UT (NPI 1568029957).
Provider details
- NPI number
- 1568029957
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Travis James, Owner/Physician(435) 554-1182
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- MOHS-Micrographic Surgery Physician207ND0101X
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 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
Other names (DBA / former)
- Doing business as
- Providence Dermatology
Additional practice locations (1)
- 950 Medical Dr Ste 311Brigham City, UT 84302-4724Phone: (435) 554-1182Fax: (435) 554-1950
Registry dates
- Enumerated
- 2019-05-22
- Last updated
- 2025-06-16
- Certified
- 2025-06-16
Frequently asked questions
- What is Providence Dermatology LLC's NPI number?
- Providence Dermatology LLC's National Provider Identifier (NPI) is 1568029957, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Providence Dermatology LLC?
- Providence Dermatology LLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Providence Dermatology LLC located?
- Providence Dermatology LLC's practice location on file with NPPES is 169 N Gateway Dr Ste 100, Providence, UT 84332-9860.
- What is Providence Dermatology LLC's phone number?
- The practice phone number listed in the NPPES registry for Providence Dermatology LLC is (541) 999-4475.
- Does Providence Dermatology LLC accept Medicare?
- Providence 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 Providence Dermatology LLC?
- The authorized official listed on Providence Dermatology LLC's NPPES record is Travis James, Owner/Physician. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Providence Dermatology LLC's NPI active?
- Yes — Providence Dermatology LLC's NPI (1568029957) is active in the NPPES registry as of the last update on 2025-06-16.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.