Cibolo Creek Dermatology Group

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

J9523 Issued in TX

Legal business name

CIBOLO CREEK DERMATOLOGY GROUP

Practice address

120 Dietert Ave BLDG Ste 300
Boerne, TX 78006-2406

Phone

(830) 971-9151

Fax

(830) 331-2475

NPI assigned

Mar 22, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Mary Adair

Title

Billing

Phone

(830) 214-7960

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

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

• Shannan Elizabeth McCann, M.D.

  • Dermatology Physician
  • San Antonio, TX
  • NPI 1710968227
  Medicare reassignment Care Compare group NPD
• Monica L McCrary, MD

  • Dermatology Physician
  • Boerne, TX
  • NPI 1710042064
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1083118111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2156",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780063602",
            "telephone_number": "830-971-9151",
            "fax_number": "830-331-2475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 DIETERT AVE BLDG STE 300",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062406",
            "telephone_number": "830-971-9151",
            "fax_number": "830-331-2475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIBOLO CREEK DERMATOLOGY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-22",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "ADAIR",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "830-214-7960",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "J9523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Haydee Chavez, M.D.
• Lauren Alexandria Chavez
• Richard L Childers, DPM
• Cibolo Counseling and Life Coaching
• Cibolo Creek Allergy PA
• Cindabarrella Medical PLLC
• Katherine Martin Cirbo, PSYD
• Joyce K Clair, APN
• Corrie Lynn Clark, RDN, LD
• Joan Macfarlane Clark, L.C.S.W.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.