Active NPI
Central Texas Dermatology, PA
- Specialist
- West Lake Hills, TX
National Provider Identifier
1164566246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- F4405
- Legal business name
- CENTRAL TEXAS DERMATOLOGY, PA
- Practice address
- 102 Westlake Dr
#100
West Lake Hills, TX 78746 - Phone
- (512) 327-7779
- NPI assigned
- Feb 20, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Debra Petrie, BILLER
- Title
- Biller/Credentialer
- Phone
- (512) 327-8449
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | F4405 | TX | Primary |
Addresses
Primary practice location
102 Westlake Dr
#100
West Lake Hills, TX 78746
Mailing address
102 Westlake Dr
Ste 100
West Lake Hills, TX 78746-5373
Phone (512) 327-7779
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100922000226 | TX | Part B Supplier - Clinic/Group Practice | 7113043654 |
Receives reassigned benefits from 10 practitioners Practice locations: West Lake Hills, TX |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0505556 | Central Texas Dermatology | Compliance | Jul 14, 2027 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 11
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Austin, TX
- NPI 1184866790
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1694563200000",
"number": "1164566246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 WESTLAKE DR",
"address_2": "STE 100",
"city": "WEST LAKE HILLS",
"state": "TX",
"postal_code": "787465373",
"telephone_number": "512-327-7779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 WESTLAKE DR",
"address_2": "#100",
"city": "WEST LAKE HILLS",
"state": "TX",
"postal_code": "78746",
"telephone_number": "512-327-7779"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CENTRAL TEXAS DERMATOLOGY, PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-20",
"last_updated": "2023-09-13",
"certification_date": "2023-09-13",
"status": "A",
"authorized_official_last_name": "PETRIE",
"authorized_official_first_name": "DEBRA",
"authorized_official_title_or_position": "BILLER/CREDENTIALER",
"authorized_official_telephone_number": "512-327-8449",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "BILLER"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "TX",
"license": "F4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Lake Hills, TX
- Dodie Sides Cashell, M.S., CCC-SLP
- Maritza Castaneda, M.S., SLP
- Rita Maddalena Castriotta, D.C.
- Angel Anthony Castro
- Center for Cosmetic Dentistry West Austin
- Central Texas Rhuematology P.a.
- Central Texas Surgical Assist, L.L.C.
- Eduardo J. Cepeda, M.D.
- Carissa Cerda, PH.D.
- Chasee Suzanne Chappell Hudgins, PSY.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.