NPIMap

Organization Active NPI

Clear Lake Dermatology, PLLC

Doing business as Clear Lake Dermatology

  • Dermatology Physician
  • Webster, TX
National Provider Identifier
1255686465
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CLEAR LAKE DERMATOLOGY, PLLC
Doing business as
Clear Lake Dermatology
Practice address
13938 Highway 3 Unit 100
Webster, TX 77598-1622
Phone
(281) 332-9681
Fax
(281) 332-5957
NPI assigned
Jul 13, 2012
Last updated
Jan 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Authorized official

Name
Dr. Narin Apisarnthanarax, M.D.NPI 1669506663
Title
Managing Physician, Owner
Phone
(281) 332-9681

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

13938 Highway 3 Unit 100
Webster, TX 77598-1622

Mailing address

13938 Highway 3 Unit 100
Webster, TX 77598-1622
Phone (281) 332-9681

Other names 1

  • Clear Lake Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120911000359 TX Part B Supplier - Clinic/Group Practice 6800044181 Receives reassigned benefits from 6 practitioners
Practice locations: Webster, TX

National Provider Directory

National Provider Directory

Locations

2508 Gulf Fwy S
League City, TX 77573

2508 Gulf Fwy S
Ste 110
League City, TX 77573
Phone (281) 310-5881

450 W Medical Center Blvd
Ste 309
Webster, TX 77598
Phone (281) 332-9681

Practitioners & affiliated clinicians

Practitioners 7

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": "1342137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1255686465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13938 HIGHWAY 3 UNIT 100",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775981622",
            "telephone_number": "281-332-9681",
            "fax_number": "281-332-5957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13938 HIGHWAY 3 UNIT 100",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775981622",
            "telephone_number": "281-332-9681",
            "fax_number": "281-332-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR LAKE DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-13",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "APISARNTHANARAX",
        "authorized_official_first_name": "NARIN",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN, OWNER",
        "authorized_official_telephone_number": "281-332-9681",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clear Lake Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clear Lake Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Webster, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; 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.