Protean Dermatology Consulting, LLC is a Dermatology Physician (organization) practicing in Bend, Oregon. The National Provider Identifier (NPI) is #1326864059, which was assigned on November 26, 2024, and the registration record was last updated on November 26, 2024. The practitioner's main practice location is at 360 Sw Bond St Ste 310, Bend, OR 97702-3556; the contact telephone number is 8554575593. The primary taxonomy of Protean Dermatology Consulting, LLC is Dermatology Physician (207N00000X). The authorized official for Protean Dermatology Consulting, LLC is John E Jackson (Physician Owner).
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
| NPI | 1326864059 |
| Entity Type | Organization |
| Organization Name | PROTEAN DERMATOLOGY CONSULTING, LLC |
| Provider Name | PROTEAN DERMATOLOGY CONSULTING, LLC |
| Practice Address |
360 Sw Bond St Ste 310 Bend OR 97702-3556 |
| Practice Telephone | 8554575593 |
| Mailing Address |
360 Sw Bond St Ste 310 Bend OR 97702-3556 |
| Mailing Telephone | 8554575593 |
| Certification Date | 2024-11-26 |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2024-11-26 |
| Is Organization Subpart | N |
| Official Name | JOHN E JACKSON |
| Official Title | PHYSICIAN OWNER |
| Credential | MD |
| Telephone | 8554575593 |
| Primary | Code | Classification | Specialization | Taxonomy Group | License Number | License State |
|---|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 193400000X SINGLE SPECIALTY GROUP |
| Code | 207N00000X |
| Taxonomy | Dermatology Physician |
| Classification | Dermatology |
| Grouping | Allopathic & Osteopathic Physicians |
| Definition: A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Stratum Dermatology, PLLC | 504 Cottage St, Springfield, MA 01104-3219 | Dermatology Physician | 2024-12-21 |
| Forefront Dermatology, S.C. · Knight Dermatology, A Forefront Dermatology Practice | 3200 N Wickham Rd Ste 5, Melbourne, FL 32935-2321 | Dermatology Physician | 2024-12-16 |
| Face Candy | 5381 Crooks Rd, Troy, MI 48098-2820 | Dermatology Physician | 2025-01-10 |
| Altius Wound Solutions Medical Group Inc | 1055 E Colorado Blvd Fl 5, Pasadena, CA 91106-2327 | Dermatology Physician | 2024-12-19 |
| Forefront Dermatology, S.C. · Knight Dermatology, A Forefront Dermatology Practice | 1035 Primera Blvd Ste 1041, Lake Mary, FL 32746-2193 | Dermatology Physician | 2024-12-16 |
| Skn Institute | 105 S York St Ste 500, Elmhurst, IL 60126-3454 | Dermatology Physician | 2024-12-25 |
| Bruna Galvao De Oliveira Wafae | 330 Brookline Ave # 522, Boston, MA 02215-5491 | Dermatology Physician | 2025-01-08 |
| Gunnison Valley Hospital | 405 Elk Ave, Crested Butte, CO 81224-5434 | Dermatology Physician | 2025-01-11 |
| Ll Advanced Aesthetics | 750 Broad St Ste 104, Shrewsbury, NJ 07702-4230 | Dermatology Physician | 2024-12-19 |
| Forefront Dermatology, S.C. · Knight Dermatology, A Forefront Dermatology Practice | 801 N Orange Ave Ste 520, Orlando, FL 32801-5202 | Dermatology Physician | 2024-12-16 |
| Find all providers with the same taxonomy | |||
| Street Address |
360 SW BOND ST STE 310 |
| City | BEND |
| State | OR |
| Zip Code | 97702-3556 |
| Country | US |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Amy Gouley Snow | 360 Sw Bond St Ste 310, Bend, OR 97702-3556 | Medical Physician Assistant | 2005-12-07 |
| A & M Snow, Inc. · Snow Dermatology | 360 Sw Bond St Ste 310, Bend, OR 97702-3556 | Dermatology Physician | 2024-07-31 |
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Shaylynne Danielle Kalberg · Shaylynne Danielle Caito | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Clinical Social Worker | 2020-02-28 |
| Eric Ford | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Student in an Organized Health Care Education/Training Program | 2016-04-13 |
| Jamie Lockwood | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Mental Health Counselor | 2022-11-15 |
| Adrienne Andeen | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Clinical Social Worker | 2017-11-10 |
| Erica Jenelle Burton · Erica Jenelle Defilippis | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Student in an Organized Health Care Education/Training Program | 2023-10-31 |
| Lesley Srikantaiah | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Clinical Social Worker | 2018-03-03 |
| Pamela Seidel | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Social Worker | 2021-01-11 |
| Anna Sarah Esko | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Clinical Social Worker | 2018-10-08 |
| John H Walkenhorst | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Clinical Social Worker | 2011-02-03 |
| Rachel Mckenzie Haase | 360 Sw Bond St Ste 330, Bend, OR 97702-3556 | Psychiatric/Mental Health Nurse Practitioner | 2022-07-22 |
| Find all providers in the same zip code | |||
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Jennifer Trembley | 805 Sw Industrial Way, Suite 8, Bend, OR 97702 | Massage Therapist | 2017-12-29 |
| Breathe Deep Dental LLC | 61583 Se 27th St, Suite Tbd, Bend, OR 97702 | Dental Clinic/Center | 2022-12-12 |
| Meadowlark Counseling Services LLC | 70 Sw Century Dr Ste 100, Bend, OR 97702 | Mental Health Clinic/Center (Including Community Mental Health Center) | 2023-07-13 |
| Jared R. Anderson, Dds, PC · Select Care Dental | 499 Sw Upper Terrace Dr. #B, Bend, OR 97702 | Dentist | 2017-10-10 |
| Praxis Health, PC · Praxis Medical Group Inc | 1140 Sw Simpson Avenue, Suite 100, Bend, OR 97702 | Durable Medical Equipment & Medical Supplies | 2019-06-10 |
| Shift Bend Functional Medicine | 151 Sw Shevlin Hicks Dr, Suite #1, Bend, OR 97702 | Family Medicine Physician | 2019-12-26 |
| Bestfit Dme, Inc. | 1001sw Disk Drive, Bend, OR 97702 | Durable Medical Equipment & Medical Supplies | 2024-07-09 |
| Isata K Massaquoi · Isata Sibley | 60164 Crater Rd, Bend, OR 97702 | Massage Therapist | 2018-07-16 |
| Cassandra Mari Wheeler | 296 Sw Columbia Street, Suite D-1, Bend, OR 97702 | Massage Therapist | 2016-11-16 |
| Jacob Rehder | 19717 Mt Batchelor Dr, #226, Bend, OR 97702 | Mental Health Counselor | 2020-09-15 |
| Find all providers in the same zip code | |||
| Provider Name | Address | Taxonomy | Enumeration Date |
|---|---|---|---|
| Clinton Village Convalescent Hospital · Protean Healthcare | 1833 10th Ave, Oakland, CA 94606-3023 | Skilled Nursing Facility | 2007-01-03 |
| Protean Surgical Assistants PLLC | 11710 Shoal Landing St, Pearland, TX 77584-8750 | Medical-Surgical Registered Nurse | 2012-07-28 |
| D-Trio Management LLC · Protean Testing Center LLC | 1408 Dusky Thrush St, Desoto, TX 75115-7656 | Lodging Provider | 2022-01-13 |
| Forefront Dermatology - Pacific, P.C. · Kalia Dermatology & Laser Center, A Forefront Dermatology Practice | 15055 Los Gatos Blvd Ste 100, Los Gatos, CA 95032-2056 | Dermatology Physician | 2022-06-07 |
| Eastside Dermatology, Inc. · Eastside Dermatology & Skin Care Center, Eastside Dermatology of Hilla | 150 Taylor Station Rd, Suite 250, Columbus, OH 43213 | Procedural Dermatology Physician | 2007-01-17 |
| Forefront Dermatology, S.C. · Arizona Dermatology Group, A Forefront Dermatology Practice | 820 Ainsworth Dr Ste A, Prescott, AZ 86301-1613 | Dermatology Physician | 2024-09-06 |
| Forefront Dermatology, S.C. · Arizona Dermatology Group, A Forefront Dermatology Practice | 830 Ainsworth Dr, Prescott, AZ 86301-1630 | Dermatology Physician | 2021-11-01 |
| East Bay Dermatology Medical Group Inc. · Center for Dermatology Cosmetic and Laser Surgery | 1158 Jacklin Rd, Milpitas, CA 95035-3700 | Specialist | 2007-10-05 |
| Forefront Dermatology Sc · Arizona Dermatology Group, A Forefront Dermatology Practice | 203 S Candy Ln # 14, Cottonwood, AZ 86326-4120 | Dermatology Physician | 2024-02-15 |
| Forefront Dermatology, S.C. · Tennessee River Dermatology, A Forefront Dermatology Practice | 2471 Helton Dr, Florence, AL 35630-1067 | Dermatology Physician | 2020-09-15 |
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This dataset includes over five million health care providers who are assigned National Provider Identifier (NPI) in the National Plan and Provider Enumeration System (NPPES), developed by the Centers for Medicare & Medicaid Services (CMS). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under Health Insurance Portability and Accountability Act (HIPAA). Each provider is registered with the NPI, full name, status, address, taxonomy, other identifiers, etc.
| Subject | Transparency and Disclosure |
| Jurisdiction | Federal |
| Data Provider | National Plan and Provider Enumeration System (NPPES), by the Centers for Medicare & Medicaid Services (CMS) |
| Source | download.cms.gov |
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers and all health plans and health care clearinghouses, who must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). All health care providers who are HIPAA-covered entities, whether individuals or organizations, must get an NPI. A HIPAA-covered entity is a health care provider that conducts certain transactions in electronic form, or a health care clearinghouse, or a health plan (including commercial plans, Medicare, and Medicaid). Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to health care providers. The National Provider Indentifier (NPI) has been the standard identifier for all HIPAA-covered entities (health care providers) since May 23, 2007. Small health plans were required to obtain and use an NPI by May 23, 2008. This dataset includes over five million health care providers (individuals and organizations) who are assigned NPI. The provider data elements are disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) under the Freedom of Information Act (FOIA), as listed in the NPPES Data Dissemination Notice (CMS-6060-N). The NPI final rules define the following elements which required to be disclosed as determined by Department of Health & Human Services (HHS): NPI, Entity Type, Provider Name, Credential, Business Mailing Address, Business Location Address, Healthcare Provider Taxonomy Code, Other Provider Identifier, Provider Enumeration Date, NPI Deactivation Date, Provider License Number, Authorized Official Name and Contact Information. |