Blue Valley Dermatology LLC
NPI 1104354794ActiveOrganization· Dermatology· Overland Park, KS
Dermatology in Overland Park, Kansas, registered in NPPES in May 2017. The authorized official on file is Tom Tkachuk, Manager. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104354794 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 26, 2017 |
| Last updated in NPPES | Oct 25, 2021 |
| Certified by provider | Oct 25, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | 04-36968 | KS |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (KS) |
|---|
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