Epiphany Dermatology PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

Q1815 Issued in TX

Legal business name

EPIPHANY DERMATOLOGY PA

Practice address

7106 Sanger Avenue
Waco, TX 76712-3928

Phone

(254) 537-1265

Fax

(254) 537-1310

NPI assigned

Oct 30, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Gheorghe Pusta

Title

Ceo

Phone

(512) 628-0465

Specialties & licenses 3

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 182

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

• Yasser A. Albahrani, M.D.

  • MOHS-Micrographic Surgery Physician
  • Desoto, TX
  • NPI 1427284710

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• Eloise Atkinson-Garza, M.D.

  • Dermatology Physician
  • San Antonio, TX
  • NPI 1154339455

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• Justin Peter Bandino, MD

  • General Practice Physician
  • Jbsa Randolph, TX
  • NPI 1780828863

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• Samantha Monique Black, MD

  • Dermatology Physician
  • Bedford, TX
  • NPI 1891375465

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• Kaitlin C. Blankenship, MD

  • MOHS-Micrographic Surgery Physician
  • Denton, TX
  • NPI 1992159909

  Mohs-Micrographic Surgery, TX

  Medicare reassignment Care Compare group NPD
• Jason L. Blaser, MD

  • MOHS-Micrographic Surgery Physician
  • Tyler, TX
  • NPI 1265477681

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• James Ray Bond Jr., M.D.

  • Dermatology Physician
  • Grapevine, TX
  • NPI 1659375616

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• Eugene Nathaniel Brooks, M.D.

  • Dermatology Physician
  • El Paso, TX
  • NPI 1568812634

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• Garrett W Camp, FNP-C

  • Nurse Practitioner
  • Texarkana, TX
  • NPI 1649756198

  Dermatology, TX

  Medicare reassignment Care Compare group NPD
• Cynthia Campos, FNP-C

  • Family Nurse Practitioner
  • El Paso, TX
  • NPI 1972792737

  TX

  Medicare reassignment Care Compare group NPD
• Pamela Ceku, PA-C

  • Physician Assistant
  • Plano, TX
  • NPI 1891484069

  TX

  Medicare reassignment Care Compare group NPD
• Cary Daniel Chisholm, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Waco, TX
  • NPI 1346498755

  TX

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1043615263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH ROAD 2222, BLDG 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787303255",
            "telephone_number": "512-628-0465",
            "fax_number": "512-628-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7106 SANGER AVENUE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123928",
            "telephone_number": "254-537-1265",
            "fax_number": "254-537-1310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-30",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-628-0465",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "Q1815",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TX",
            "license": "Q1815",
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Lauren English, D.P.M.
• Ennoble Hospice TX LLC
• Enrichment Training and Counseling Solutions, Inc.
• Mark Anthony Anahaw Entrolezo, PT
• Ep Homecare LLC
• Epiphany Soul
• Ann Elizabeth Erickstad, MD
• Hannah Kathryn Ermon
• Shelby Erwin
• Esc IV, LP

• All providers in Waco, TX
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.