NPIMap

Organization Active NPI

Epiphany Dermatology of Iowa, PLC

  • Dermatology Physician
  • Cedar Rapids, IA
National Provider Identifier
1104451749
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EPIPHANY DERMATOLOGY OF IOWA, PLC
Practice address
5264 Council St NE Ste 700
Cedar Rapids, IA 52402-2477
Phone
(319) 363-9963
Fax
(319) 363-0520
NPI assigned
Mar 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Gheorghe Pusta
Title
Executive Director
Phone
(512) 628-0465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

5264 Council St NE Ste 700
Cedar Rapids, IA 52402-2477

Mailing address

7300 Ranch Rd. 2222, BLDG 1, Ste 200
Austin, TX 78730-3255
Phone (512) 628-0465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200424001980 IA Part B Supplier - Clinic/Group Practice 7618307034 Receives reassigned benefits from 19 practitioners
Practice locations: Coralville, IA; Pella, IA; Marengo, IA; Des Moines, IA; Cedar Rapids, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0386795Epiphany Dermatology of Iowa, PLC5264 Council St NE Ste 700, Cedar Rapids, IA 52402ComplianceJan 5, 2028

National Provider Directory

National Provider Directory

Locations

716 5th Ave SE
Cedar Rapids, IA 52401
Phone (319) 363-9936

2605 Washington St
Pella, IA 50219
Phone (641) 620-9119

2605 Washington St
Ste C
Pella, IA 50219

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1104451749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH RD. 2222, BLDG 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787303255",
            "telephone_number": "512-628-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5264 COUNCIL ST NE STE 700",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524022477",
            "telephone_number": "319-363-9963",
            "fax_number": "319-363-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF IOWA, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "512-628-0465"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.