Active NPI
Clear Creek Dermatology
- Dermatology Physician
- Llano, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Emily Liga Prosise, MD
- Title
- Owner
- Phone
- (830) 953-1700
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
904 Ford St
Llano, TX 78643-2345
Mailing address
904 Ford St
Llano, TX 78643-2345
Phone (830) 953-1700
Other practice location 1
507 W Fm 2147 Ste 204
Marble Falls, TX 78654-6279
Phone (830) 953-1700
Other practice location 2
205 W Windcrest St Ste 340
Fredericksburg, TX 78624-4478
Phone (830) 953-1711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220428001751 | TX | Part B Supplier - Clinic/Group Practice | 8325435977 |
Receives reassigned benefits from 8 practitioners Practice locations: Fredericksburg, TX; Llano, TX; Marble Falls, TX |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2258312 | Clear Creek Dermatology | Compliance | Jan 2, 2027 |
| 45D2280400 | Clear Creek Dermatology Fredericksburg | Compliance | Feb 20, 2028 |
National Provider Directory
National Provider DirectoryLocations
904 Ford St
Llano, TX 78643
Phone (830) 953-1700
906 Ford St
Llano, TX 78643
Phone (325) 248-6309
507 W FM 2147
Marble Falls, TX 78654
507 W FM 2147
Ste 204
Marble Falls, TX 78654
Phone (830) 953-1700
607 Gtwy Central
Ste 200
Marble Falls, TX 78654
Phone (830) 953-1700
102 Westlake Dr
Ste 100
West Lake Hills, TX 78746
Phone (512) 327-7779
Practitioners & affiliated clinicians
Practitioners 21
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- MOHS-Micrographic Surgery Physician
- West Lake Hills, TX
- NPI 1689102527
Dermatology, TX
-
- Dermatology Physician
- West Lake Hills, TX
- NPI 1972045987
Dermatology, TX
-
- MOHS-Micrographic Surgery Physician
- Austin, TX
- NPI 1245686609
Dermatology, TX
-
- Medical Physician Assistant
- Austin, TX
- NPI 1861480881
-
- Plastic Surgery Physician
- Austin, TX
- NPI 1194912469
-
- Family Nurse Practitioner
- Austin, TX
- NPI 1184866790
NPI Registry JSON
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": []
}Other providers in Llano, TX
Sources for this page
- 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.