NPIMap

Organization Active NPI

Academy Dermatologists Group LLC

  • Procedural Dermatology Physician
  • Tucson, AZ
National Provider Identifier
1144588047
Registry record updated Feb 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
11617 Issued in AZ
Legal business name
ACADEMY DERMATOLOGISTS GROUP LLC
Practice address
6648 E Carondelet Dr
Tucson, AZ 85710-2119
Phone
(520) 886-8151
Fax
(520) 885-1404
NPI assigned
Apr 27, 2012
Last updated
Feb 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2018

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

Authorized official

Name
Gheorghe Pusta
Title
Ceo
Phone
(512) 960-5760

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X RN081679 AZ
Procedural Dermatology Physician 207NS0135X 11617 AZ Primary

Addresses

Primary practice location

6648 E Carondelet Dr
Tucson, AZ 85710-2119

Mailing address

6601 Vaught Ranch Rd Ste 200
Austin, TX 78730-2309
Phone (512) 628-0465

National Provider Directory

National Provider Directory

Locations

6648 E Carondelet Dr
Tucson, AZ 85710
Phone (520) 886-8151

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519776000000",
    "number": "1144588047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 VAUGHT RANCH RD STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787302309",
            "telephone_number": "512-628-0465",
            "fax_number": "512-628-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6648 E CARONDELET DR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857102119",
            "telephone_number": "520-886-8151",
            "fax_number": "520-885-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMY DERMATOLOGISTS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-27",
        "last_updated": "2018-02-28",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-960-5760"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "RN081679",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "11617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.