MOUNTAIN WEST DERM - BLACKHART PLLC – MOHS-Micrographic Surgery Physician, NPI 1740633015
MOHS-Micrographic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MOUNTAIN WEST DERM - BLACKHART PLLC
10479 Double R Blvd
Reno, NV 895218905
Phone: (775) 850-8600
Fax: (775) 850-8665
Type: Location
9672 S McCarran Blvd
Reno, NV 895239205
Phone: (775) 324-0699
Fax: (775) 323-6814
Type: Location
3640 Warren Way Ste 200
Reno, NV 895095240
Phone: (775) 324-0699
Fax: (775) 826-4820
Type: Location
3640 Warren Way Ste 100
Reno, NV 895095240
Phone: (775) 324-0699
Fax: (775) 336-3666
Type: Location
3950 Gs Richards Blvd
Carson City, NV 897038457
Phone: (775) 882-8777
Fax: (775) 888-8062
Type: Location
5419 Reno Corporate Dr
Reno, NV 895112250
Phone: (775) 324-0699
Fax: (775) 323-6814
Type: Location
640 W MOANA LN
RENO, NV 895094903
Phone: (775) 324-0699
Fax: (775) 323-6814
Type: Location
GS Richards Boulevard, Carson City, Nevada, 89703, United States
CARSON CITY, NV 897038457
Phone: (775) 882-8777
Fax: (775) 888-8062
Type: Location
917 Tahoe Blvd Ste 101
Incline Village, NV 894517484
Phone: (775) 324-0699
Fax: (775) 298-7324
Type: Location
607 S Maine St
Fallon, NV 894063801
Phone: (775) 428-1007
Fax: (775) 888-8062
Type: Location
1825 Pinion Rd Ste F
Elko, NV 898018319
Phone: (775) 299-4778
Fax: (775) 299-4690
Type: Location
4814 Sparks Blvd
Sparks, NV 894368219
Phone: (775) 324-0699
Fax: (775) 451-7501
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: 2016-10-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-10-31 (953 days ago).
Enrollment records
1
Earliest due date
2023-10-31
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 |
|---|---|---|---|---|
| O20161031002278 | O | Clinic/Group Practice | NV | 2023-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 89521)
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