Epiphany Dermatology of Iowa, PLC

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

Last updated

Dec 7, 2023By the provider in NPPES

Organization subpart

No

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

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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

Locations

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tonia K Ackerman, ARNP

  • Family Nurse Practitioner
  • Pleasant Hill, IA
  • NPI 1932142692
  Medicare reassignment Care Compare group NPD
• David Paul Boysen, M.D.

  • Dermatology Physician
  • Coralville, IA
  • NPI 1972687911
  Medicare reassignment Care Compare group NPD
• Thomas Charles Boysen, M.D.

  • Dermatology Physician
  • Coralville, IA
  • NPI 1851475750
  Medicare reassignment Care Compare group NPD
• Heather Marie Ciliberto, MD

  • Dermatology Physician
  • Iowa City, IA
  • NPI 1447408869
  Medicare reassignment Care Compare group NPD
• Alexandra Jane Collins, FNP-C

  • Nurse Practitioner
  • Coralville, IA
  • NPI 1841068855
  Medicare reassignment Care Compare group NPD
• Megan N Ferguson, ARNP

  • Family Nurse Practitioner
  • Pleasant Hill, IA
  • NPI 1558698753
  Medicare reassignment Care Compare group NPD
• Kathryn Patricia Kaufman, PA-C

  • Physician Assistant
  • Coralville, IA
  • NPI 1144807876
  Medicare reassignment Care Compare group NPD
• Jennifer Lillian Palmer, M.D.

  • Dermatology Physician
  • Pella, IA
  • NPI 1801893862
  Medicare reassignment Care Compare group NPD
• Kristi Robson, MD

  • Specialist
  • Coralville, IA
  • NPI 1730128653
  Medicare reassignment Care Compare group NPD
• Logan Skelley, M.D.

  • MOHS-Micrographic Surgery Physician
  • Coralville, IA
  • NPI 1851710727

  Dermatology

  Medicare reassignment Care Compare group NPD
• Hannah Thompson, MD

  • Dermatology Physician
  • Coralville, IA
  • NPI 1861060220
  Medicare reassignment Care Compare group NPD
• Hobart W Walling, M.D.

  • MOHS-Micrographic Surgery Physician
  • Coralville, IA
  • NPI 1477506814
  Medicare reassignment Care Compare group NPD

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": []
}

• Naomi Jean Engelken
• Joshua Englund, PT
• Ann Leigh Ennen
• Stephanie Ennen, LCPC
• Susan Lois Enzle, PHD
• Richard John Eppey II, M.D.
• Erez Healthcare Group LLC (Northbrook Healthcare and Rehabilitation Center)
• Alexis Erger, LMSW
• Jena Lee Erger, MA, MFT-T
• Christine D. Erickson, NCC, LMHC

• Dermatology Physician in Cedar Rapids, IA
• Providers in Cedar Rapids, IA by specialty
• Dermatology Physician in Iowa

• 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.