Basin Dermatology

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BASIN DERMATOLOGY

Practice address

4214 Andrews Hwy Ste 110
Midland, TX 79703-4864

Phone

(432) 689-2491

Fax

(432) 991-1158

NPI assigned

Jan 27, 2021

Organization subpart

No

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

Authorized official

Name

Candace Wynne

Title

Credentialing Manager

Phone

(432) 686-6605

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 4

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

• Michael Thomas Caglia, M.D.

  • Dermatology Physician
  • Midland, TX
  • NPI 1568789550
  Medicare reassignment NPD
• Nicole Marie Nutter, PA-C

  • Physician Assistant
  • Midland, TX
  • NPI 1184258378
  Medicare reassignment
• Amanda Rae Miller, APRN, FNP-C

  • Family Nurse Practitioner
  • Fort Worth, TX
  • NPI 1013524073
  NPD
• Morgan Blake Wake, PA-C

  • Physician Assistant
  • San Angelo, TX
  • NPI 1992315899

  Dermatology

  NPD

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1063003754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4214 ANDREWS HWY STE 240",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797034817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4214 ANDREWS HWY STE 110",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797034864",
            "telephone_number": "432-689-2491",
            "fax_number": "432-991-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASIN DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "WYNNE",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "432-686-6605"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Michelle Barton, LCDC
• Abigail Barzyk, PA-S
• Basin Body
• Basin Cardiothoracic & Vascular Surgery Associates
• Basin Cardiothoracic Surgical Associates
• Basin Neurosurgical and Spine Associates
• Basin Pediatrics, LLC
• Basin Rheumatology PLLC
• Basin Urgent Care
• Ashley Nicole Bassett

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.