OrganizationActive
Mountain West Derm - Blackhart PLLC
NPI 1891467577 · Dermatology Physician · Roseburg, OR
Provider details
- NPI number
- 1891467577
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jeffrey Shackelton, Owner(775) 283-4086
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(61/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 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
341 Nw Medical Loop Ste 110
Roseburg, OR 97471-5546
Phone: (541) 440-2165
Fax: (541) 440-8932
Street-level locationGet directions
Mailing address
341 Nw Medical Loop Ste 110
Roseburg, OR 97471-5546
Registry dates
- Enumerated
- 2021-10-01
- Last updated
- 2021-10-04
- Certified
- 2021-10-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.