Active NPI
Elite Dermatology, PLLC
- Dermatology Physician
- Katy, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- ELITE DERMATOLOGY, PLLC
- Practice address
- 4603 FM 1463 Rd Ste 100
Katy, TX 77494-6545 - Phone
- (281) 612-0050
- Fax
- (281) 612-0051
- NPI assigned
- Oct 12, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Connie Wang
- Title
- MD
- Phone
- (281) 612-0050
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
4603 FM 1463 Rd Ste 100
Katy, TX 77494-6545
Mailing address
4603 FM 1463 Rd Ste 100
Katy, TX 77494-6545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171208000975 | TX | Part B Supplier - Clinic/Group Practice | 8729345285 |
Receives reassigned benefits from 32 practitioners Practice locations: Tomball, TX; Pearland, TX; Kingwood, TX; Houston, TX; Fulshear, TX |
National Provider Directory
National Provider DirectoryLocations
27131 Fulshear Bend Dr
Fulshear, TX 77441
Phone (281) 612-0050
2222 N Shepherd Dr
Ste 102
Houston, TX 77008
Phone (281) 501-5624
20326 State Highway 249
Ste 400
Houston, TX 77070
Phone (281) 501-5599
4505 Kingwood Dr
Ste 185
Kingwood, TX 77345
Phone (281) 747-5533
1930 Pearland Pkwy
Ste 154
Pearland, TX 77581
Phone (281) 816-5503
455 School St
Ste 49
Tomball, TX 77375
Phone (281) 351-9823
Practitioners & affiliated clinicians
Practitioners 34
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Student in an Organized Health Care Education/Training Program
- San Antonio, TX
- NPI 1578025615
TX
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507766400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1507766400000",
"number": "1104337526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4603 FM 1463 RD STE 100",
"city": "KATY",
"state": "TX",
"postal_code": "774946545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4603 FM 1463 RD STE 100",
"city": "KATY",
"state": "TX",
"postal_code": "774946545",
"telephone_number": "281-612-0050",
"fax_number": "281-612-0051"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELITE DERMATOLOGY, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-10-12",
"last_updated": "2017-10-12",
"status": "A",
"authorized_official_last_name": "WANG",
"authorized_official_first_name": "CONNIE",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "281-612-0050"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Katy, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; 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.