Clarity Dermatology PLLC
Organization Active NPI Dermatology Physician · Lancaster, TX
NPI 1093447252 · NPPES record last updated Jun 27, 2022
Key facts
- NPI
- 1093447252
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- CLARITY DERMATOLOGY PLLC
- Practice address
- 2500 W Pleasant Run Rd Ste 215
Lancaster, TX 75146-1170 - Phone
- (945) 230-4312
- Fax
- (972) 478-0563
- NPI assigned
- Jun 27, 2022
- Organization subpart
- No
Authorized official
- Name
- Elizabeth Wilder, MD
- Title
- President
- Phone
- (469) 215-4699
Practitioners 2
-
Dario Kivelevitch, M.D.
-
Elizabeth Wilder, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2273983 | Clarity Dermatology | Provider-performed microscopy | Dec 20, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221129000045 | TX | Part B Supplier - Clinic/Group Practice | 3274901012 |
Receives reassigned benefits from 1 practitioner Practice locations: Lancaster, TX |
National Provider Directory
Locations
2500 W Pleasant Run Rd
Ste 215
Lancaster, TX 75146
Phone (945) 230-4312
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
2500 W Pleasant Run Rd Ste 215
Lancaster, TX 75146-1170
Mailing address
2432 Worthington St
Dallas, TX 75204-2503
Phone (469) 215-4699
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.