Calyx Dermatology LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

CALYX DERMATOLOGY LLC

Practice address

612 Encino PL NE
Albuquerque, NM 87102-2602

Phone

(240) 367-2980

NPI assigned

Jun 4, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Catherine Tchanque-Fossuo, MD, MS, FAADNPI 1558588830

Title

Dermatologist/Mohs Surgeon

Phone

(240) 367-2980

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Catherine Ndjeukam Tchanque-Fossuo, M.D., M.S.

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1558588830
  Medicare reassignment Care Compare group NPD Authorized official
• Jennifer Marie Otero, FNP-BC

  • Family Nurse Practitioner
  • Albuquerque, NM
  • NPI 1881387736
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1003657198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5863 MAFRAQ AVE NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871146071",
            "telephone_number": "240-367-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 ENCINO PL NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022602",
            "telephone_number": "240-367-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALYX DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "TCHANQUE-FOSSUO",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "DERMATOLOGIST/MOHS SURGEON",
        "authorized_official_telephone_number": "240-367-2980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MS, FAAD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amity Calvin, MD
• Christina Luisa Calvin, PT
• Christine Diane Calvin, MS, RD, LD
• Michael V Calvin, PA
• Ana Clemencia Calvo
• Calyx Institute LLC
• Amarilis Camacho Quinones
• Cristhian Camacho
• Christopher Camarata
• Anthony Romero Camarena, OTR/L

• MOHS-Micrographic Surgery Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• MOHS-Micrographic Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.