Padre Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

Q6096 Issued in TX

Legal business name

PADRE DERMATOLOGY PLLC

Practice address

14650 Compass St Ste 1
Corpus Christi, TX 78418-6237

Phone

(361) 867-1032

Fax

(361) 867-1018

NPI assigned

Dec 14, 2015

Organization subpart

No

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

Authorized official

Name

Ryan Travis Rogers, MDNPI 1396065470

Title

Owner

Phone

(361) 867-1032

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 1

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

• Ryan T Rogers, MD

  • MOHS-Micrographic Surgery Physician
  • Corpus Christi, TX
  • NPI 1396065470

  Dermatology

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1215302427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6696",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784666696",
            "telephone_number": "361-985-1221",
            "fax_number": "361-992-1667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14650 COMPASS ST STE 1",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784186237",
            "telephone_number": "361-867-1032",
            "fax_number": "361-867-1018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PADRE DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "361-867-1032",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "Q6096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Michael Pachuta, RN
• Jason Packard, DDS
• Kevin Earl Packard, D.D.S.
• Viviana Padilla
• Padre Behavioral Health System, LLC
• Padre Home and Clinic Healthcare, PLLC
• Padre Home Health, Inc.
• Padre Island Counseling, PLLC
• Padre Island ER Physicians PLLC
• Ana Maria Paez, MD

• Dermatology Physician in Corpus Christi, TX
• Providers in Corpus Christi, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.