NPIMap

Organization Active NPI

Warthan Dermatology Nacogdoches PLLC

  • Dermatology Physician
  • Nacogdoches, TX
National Provider Identifier
1144820135
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WARTHAN DERMATOLOGY NACOGDOCHES PLLC
Practice address
4730 NE Stallings Dr
Nacogdoches, TX 75965-1615
Phone
(936) 564-6107
Fax
(936) 564-5124
NPI assigned
Oct 28, 2020
Last updated
Mar 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Authorized official

Name
Jaclyn R Hill
Title
Practice Manager
Phone
(817) 923-8220

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X

Addresses

Primary practice location

4730 NE Stallings Dr
Nacogdoches, TX 75965-1615

Mailing address

4730 NE Stallings Dr
Nacogdoches, TX 75965-1615
Phone (817) 923-8220

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210107001968 TX Part B Supplier - Clinic/Group Practice 9638582844 Receives reassigned benefits from 4 practitioners
Practice locations: Nacogdoches, TX

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
45D0484113Warthan Dermatology Nacogdoches PLLC4730 NE Stallings Dr, Nacogdoches, TX 75965ComplianceMar 12, 2027

National Provider Directory

National Provider Directory

Locations

27150 Highway 290
Ste 100
Cypress, TX 77433
Phone (832) 533-0909

5751 Edwards Ranch Rd
Ste 101
Fort Worth, TX 76109
Phone (817) 850-1100

4730 NE Stallings Dr
Nacogdoches, TX 75965
Phone (817) 923-8220

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1144820135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 NE STALLINGS DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651615",
            "telephone_number": "817-923-8220",
            "fax_number": "817-923-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 NE STALLINGS DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651615",
            "telephone_number": "936-564-6107",
            "fax_number": "936-564-5124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARTHAN DERMATOLOGY NACOGDOCHES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-28",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "817-923-8220"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.