Clear Creek Dermatology

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CLEAR CREEK DERMATOLOGY

Practice address

904 Ford St
Llano, TX 78643-2345

Phone

(830) 953-1700

Fax

(830) 953-1717

NPI assigned

Mar 23, 2022

Last updated

Sep 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Emily Liga Prosise, MDNPI 1548272065

Title

Owner

Phone

(830) 953-1700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacquelynn T Anderson, PA

  • Physician Assistant
  • Llano, TX
  • NPI 1912626227
  Medicare reassignment Care Compare group NPD
• Olivia Mei Chen, MD

  • MOHS-Micrographic Surgery Physician
  • West Lake Hills, TX
  • NPI 1689102527

  Dermatology

  Medicare reassignment Care Compare group NPD
• Emily Liga Prosise, MD

  • Dermatology Physician
  • West Lake Hills, TX
  • NPI 1548272065
  Medicare reassignment NPD Authorized official
• Brian L Ransdell, MD

  • MOHS-Micrographic Surgery Physician
  • Spicewood, TX
  • NPI 1144361809
  Medicare reassignment Care Compare group NPD
• Quoc-Bao Duy Nguyen, MD

  • Dermatology Physician
  • Austin, TX
  • NPI 1962931766
  Medicare reassignment Care Compare group
• Samuel David Smith, PA-C

  • Medical Physician Assistant
  • Llano, TX
  • NPI 1184346280
  Medicare reassignment Care Compare group
• Lia Giannotti Stratton, FNP-C

  • Dermatology Physician
  • West Lake Hills, TX
  • NPI 1972045987
  Medicare reassignment NPD
• Megan Ann Trainor, M.D.

  • MOHS-Micrographic Surgery Physician
  • Austin, TX
  • NPI 1245686609

  Dermatology

  Medicare reassignment NPD
• Mellissa Binney, P.A.

  • Medical Physician Assistant
  • Austin, TX
  • NPI 1861480881
  NPD (past)
• Jeffrey D Cone Jr., M.D.

  • Plastic Surgery Physician
  • Austin, TX
  • NPI 1194912469
  NPD (past)
• Lilian Nicole Machuca, APRN

  • Family Nurse Practitioner
  • Austin, TX
  • NPI 1184866790
  NPD (past)
• Halliday Craige McDonald, M.D.

  • Dermatology Physician
  • West Lake Hills, TX
  • NPI 1285835603
  NPD (past)

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

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1013667161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 FORD ST",
            "city": "LLANO",
            "state": "TX",
            "postal_code": "786432345",
            "telephone_number": "830-953-1700",
            "fax_number": "830-953-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 FORD ST",
            "city": "LLANO",
            "state": "TX",
            "postal_code": "786432345",
            "telephone_number": "830-953-1700",
            "fax_number": "830-953-1717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "507 W Fm 2147 Ste 204",
            "address_purpose": "LOCATION",
            "city": "Marble Falls",
            "state": "TX",
            "postal_code": "786546279",
            "country_code": "US",
            "telephone_number": "830-953-1700",
            "fax_number": "830-953-1717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "205 W Windcrest St Ste 340",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "TX",
            "postal_code": "786244478",
            "country_code": "US",
            "telephone_number": "830-953-1711",
            "fax_number": "830-953-1717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLEAR CREEK DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-23",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "PROSISE",
        "authorized_official_first_name": "EMILY",
        "authorized_official_middle_name": "LIGA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-953-1700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Assisted Living, Inc. (Walden Court Assisted Living)
• Laura Bibb, FNP
• Steve Sheldon Cabasag Bongcawel, DPT
• Care Inn of Llano LLC (Care Inn of Llano)
• Cynthia D Chase, R.D.,L.D.
• Howell Anson Cone, M.D.
• Coryell County Memorial Hospital Authority (Hill Country Healthcare Center)
• Dignity Healthcare II LLC (Llano Nursing & Rehabilitation Center)
• Dura Med, Inc. (Lakes Area Pharmacy & Medical Equipment)
• Dura Med, Inc. (Corner Drug Store and Medical Equipment)

• Dermatology Physician in Llano, TX
• Providers in Llano, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.