Westlake Dermatology PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

WESTLAKE DERMATOLOGY PA

Practice address

507 W FM 2147
Suite 202
Marble Falls, TX 78654-6279

Phone

(512) 328-3376

Fax

(512) 306-0222

NPI assigned

May 13, 2008

Organization subpart

No

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

Authorized official

Name

Gregory A Nikolaidis, M.D.

Title

President

Phone

(512) 328-3376

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Westlake Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Westlake Dermatology PA

  • Dermatology Physician
  • Round Rock, TX
  • NPI 1477678993

  O20040804000774

  Same enrollment
• Westlake Dermatology PA

  • Dermatology Physician
  • Austin, TX
  • NPI 1518939347

  O20040804000774

  Same enrollment
• Westlake Dermatology, PA

  • Dermatology Physician
  • Alamo Heights, TX
  • NPI 1265086045

  O20040804000774

  Same enrollment
• Westlake Dermatology, PA

  • Dermatology Physician
  • Dallas, TX
  • NPI 1326692468

  O20040804000774

  Same enrollment
• Westlake Dermatology, PA

  • Dermatology Physician
  • Houston, TX
  • NPI 1437617255

  O20040804000774

  Same enrollment
• Westlake Dermatology, PA

  • Dermatology Physician
  • Lakeway, TX
  • NPI 1891029476

  O20040804000774

  Same enrollment

Practitioners 2

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

• Melinda Dawn Conroy, D.O.

  • Dermatology Physician
  • Lakeway, TX
  • NPI 1760650428
  NPD
• Alison Cyr Moseley, MD

  • Dermatology Physician
  • Round Rock, TX
  • NPI 1124462833
  NPD

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446681600000",
    "number": "1154598779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8825 BEE CAVE RD",
            "address_2": "SUITE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787464720",
            "telephone_number": "512-328-3376",
            "fax_number": "512-306-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 W FM 2147",
            "address_2": "SUITE 202",
            "city": "MARBLE FALLS",
            "state": "TX",
            "postal_code": "786546279",
            "telephone_number": "512-328-3376",
            "fax_number": "512-306-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTLAKE DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2015-11-05",
        "status": "A",
        "authorized_official_last_name": "NIKOLAIDIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-328-3376",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS GROUP#",
            "identifier": "00591T",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westlake Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John D Weber, OD
• David W Weiss, M.D.
• Jason Bennett Welch, D.O.
• Sixian Cheng Welch, D.O.
• Ellis Francis Wells II
• Whitestone Counseling, Inc.
• Christian Wilcox, RDN
• Alexander Wilkins, DO
• Matthew Wilkins
• Anthony Wilks, PHARM.D

• Dermatology Physician in Marble Falls, TX
• Providers in Marble Falls, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.

Verify at the official NPI Registry.