U-U Dermatology Division School of Medicine – Dermatology Physician, NPI 1922096114
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for U-U Dermatology Division School of Medicine
PO BOX 35145 LB 3208
SEATTLE, WA 981245145
Phone: (801) 587-6340
Fax: (801) 587-6346
Type: Mailing
50, North Medical Drive, Salt Lake City, Salt Lake County, Utah, 84113, United States
SALT LAKE CITY, UT 841320001
Phone: (801) 587-6340
Fax: (801) 587-6346
Type: Location
PO BOX 841052
LOS ANGELES, CA 900841052
Phone: (801) 581-2955
Fax: (801) 587-6346
Type: Mailing
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: 2021-08-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1012 days ago).
Enrollment records
3
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| O20031122000107 | O | Clinic/Group Practice | UT | 2023-08-31 |
| O20200316002698 | O | Clinic/Group Practice | WY | 2026-05-31 |
| O20210823000885 | O | Clinic/Group Practice | NV | 2026-08-31 |
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 98124)
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