DERMATOLOGY SPECIALISTS OF BOULDER, PC – MOHS-Micrographic Surgery Physician, NPI 1053449306
MOHS-Micrographic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DERMATOLOGY SPECIALISTS OF BOULDER, PC
2880 FOLSOM ST
SUITE #200
BOULDER, CO 803043739
Phone: (303) 442-6647
Fax: (303) 442-2696
Type: Mailing
1056 S 88TH ST
LOUISVILLE, CO 800279460
Phone: (303) 442-6647
Fax: (303) 442-2696
Type: Location
905 W 124th Ave Ste 170
Westminster, CO 802341716
Phone: (303) 442-6647
Fax: (303) 442-2696
Type: Location
36 S 18th Ave Ste H
Brighton, CO 806012452
Phone: (303) 442-6647
Fax: (303) 442-2696
Type: Location
2880 Folsom St
Suite #200
Boulder, CO 803043739
Phone: (303) 442-6647
Type: Location
776 W Eisenhower Blvd
Loveland, CO 805373157
Phone: (303) 442-6647
Type: Location
11990 Grant St Ste 300
Northglenn, CO 802331135
Phone: (303) 442-6647
Fax: (303) 442-2696
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-10-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20071004000308 | O | Clinic/Group Practice | CO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 80304)
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