Epiphany Dermatology of Oregon, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

EPIPHANY DERMATOLOGY OF OREGON, LLC

Practice address

2222 NW Lovejoy St
Suite 422
Portland, OR 97210-3033

Phone

(503) 227-7117

Fax

(503) 227-7120

NPI assigned

Nov 20, 2006

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

Secretary

Phone

(512) 628-0465

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 5

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

• Kyle Leland Horner, M.D.

  • Dermatology Physician
  • Lebanon, OR
  • NPI 1528124195
  Medicare reassignment Care Compare group NPD
• Patricia Lynn Norris, MD

  • Dermatology Physician
  • Portland, OR
  • NPI 1306873203
  Medicare reassignment Care Compare group NPD
• Lisa Blakley, PA

  • Physician Assistant
  • Portland, OR
  • NPI 1649031642
  Medicare reassignment Care Compare group
• Timothy Scott Carrasco, PA

  • Surgical Physician Assistant
  • Portland, OR
  • NPI 1598954976
  Medicare reassignment
• Jay R Arthur, PA-C

  • Medical Physician Assistant
  • Lincoln, NE
  • NPI 1083970040

  OR

  Medicare reassignment

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753056000000",
    "number": "1174697239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH ROAD 2222, BLDG 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787303255",
            "telephone_number": "512-628-0465",
            "fax_number": "512-233-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST",
            "address_2": "SUITE 422",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103033",
            "telephone_number": "503-227-7117",
            "fax_number": "503-227-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF OREGON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "SECRETARY",
        "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": []
}

• Stephanie N Entrikin, RD, LD
• Katie Enyart, LMT
• Epic Imaging PC
• Epicenter Therapeutic Bodywork and Massage LLC
• Epiphany Counseling Services, LLC
• Sarah Leigh Epley, CRM
• Tanja S Epley, DO
• Daniel Eppelsheimer
• Rhonda Eppelsheimer, CSWA
• Kaytlin Epperly, MA

• Dermatology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; 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.