Dermatology Specialists of San Antonio, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY SPECIALISTS OF SAN ANTONIO, PLLC

Practice address

2520 Broadway St Ste 202
San Antonio, TX 78215-1149

Phone

(210) 541-4884

Fax

(210) 541-4900

NPI assigned

Feb 19, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Nicole Marie Owens, MDNPI 1154312080

Title

Managing Owner

Phone

(210) 541-4884

Specialties & licenses 3

Addresses

Other identifiers 1

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 12

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

• Nicole Marie Owens, M.D.

  • Dermatology Physician
  • San Antonio, TX
  • NPI 1154312080
  Medicare reassignment Care Compare group NPD Authorized official
• Simi D Cadmus, MD

  • Dermatology Physician
  • Austin, TX
  • NPI 1720584030
  Medicare reassignment Care Compare group NPD
• Meagan Olivia Harris, M.D.

  • Dermatology Physician
  • San Antonio, TX
  • NPI 1497103527
  Medicare reassignment Care Compare group NPD
• Jay Anthony Hendrix, M.D.

  • Dermatology Physician
  • Austin, TX
  • NPI 1851304380
  Medicare reassignment Care Compare group NPD
• Quoc-Bao Duy Nguyen, MD

  • Dermatology Physician
  • Austin, TX
  • NPI 1962931766
  Medicare reassignment Care Compare group NPD
• Edward Pena Perez, MD PHD

  • Dermatology Physician
  • San Marcos, TX
  • NPI 1881755650
  Medicare reassignment Care Compare group NPD
• Valerie Fisher Shiu, MD

  • MOHS-Micrographic Surgery Physician
  • San Antonio, TX
  • NPI 1194110874

  Dermatology

  Medicare reassignment Care Compare group NPD
• Gabriella R Carrizales, PA-C

  • Physician Assistant
  • San Antonio, TX
  • NPI 1902445885
  Medicare reassignment Care Compare group
• Shirien O. Coover, P.A.-C.

  • Medical Physician Assistant
  • Austin, TX
  • NPI 1730349358
  Medicare reassignment Care Compare group
• Courtney Scamardo, PA-C

  • Physician Assistant
  • Austin, TX
  • NPI 1356720130
  Medicare reassignment Care Compare group
• Thomas Walton Schulze, M.D.

  • Dermatology Physician
  • Austin, TX
  • NPI 1073675625
  NPD
• Steven Eric Zimmet, MD, RVT, FAVPH

  • Phlebology Physician
  • Austin, TX
  • NPI 1700990736
  NPD (past)

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

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1275925869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4919 MEMORIAL HWY STE 150",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336347516",
            "telephone_number": "813-333-1512",
            "fax_number": "813-333-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 BROADWAY ST STE 202",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782151149",
            "telephone_number": "210-541-4884",
            "fax_number": "210-541-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY SPECIALISTS OF SAN ANTONIO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGING OWNER",
        "authorized_official_telephone_number": "210-541-4884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "H000R0R101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rob Ert Parris Derington, LAT
• Susan Marie Derk, OTR
• Marilyn Kay Derkowski, RPH
• Derm Docs PLLC
• Derma Dash Services, LLC
• Dermatopathology Specialists of Texas
• Jason P Deroche, D.C.
• Byron Derouselle Jr.
• Kesia Derry
• Olga Deryavko, PHARMD

• Dermatology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.