Premier Procedural Dermatology PLLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

PREMIER PROCEDURAL DERMATOLOGY PLLC

Practice address

1651 Rock Prairie Rd Ste 103
College Station, TX 77845-8652

Phone

(979) 314-5400

Fax

(979) 704-5603

NPI assigned

Aug 30, 2019

Organization subpart

No

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

Authorized official

Name

Ryan William Ahern, MDNPI 1003033838

Title

Provider/Owner

Phone

(979) 314-5400

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

Practitioners 2

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

• Ryan W Ahern, MD

  • Procedural Dermatology Physician
  • College Station, TX
  • NPI 1003033838

  Mohs-Micrographic Surgery

  Medicare reassignment NPD Authorized official
• Gabrielle Leysock

  • Medical Physician Assistant
  • College Station, TX
  • NPI 1124896774
  Medicare reassignment

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

{
    "created_epoch": "1567123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1053969287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1651 ROCK PRAIRIE RD STE 103",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458652",
            "telephone_number": "979-314-5400",
            "fax_number": "979-704-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 ROCK PRAIRIE RD STE 103",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458652",
            "telephone_number": "979-314-5400",
            "fax_number": "979-704-5603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PROCEDURAL DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-30",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A",
        "authorized_official_last_name": "AHERN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "979-314-5400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Daniel Porter, MD, MPH
• Brandon H Posvar, MD
• Sarah Poynor
• Christopher Prause
• Precision Eye Care, PLLC
• Kimberly Kay Presson, DPT
• Autumn Theresa Prestenback
• Carol D. Price, LOTA
• Erin Price, FNP-C
• Kellous Andrew Price, M.D.

• MOHS-Micrographic Surgery Physician in College Station, TX
• Providers in College Station, TX by specialty
• MOHS-Micrographic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.