Jerry Kulangara John

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1615 Hospital Pkwy Ste 306
Bedford, TX 76022-5936

Phone

(512) 628-0465

NPI assigned

Apr 15, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology PAGroup PAC ID 3971827791, 106 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.97 of 100Reported as group

Quality

76.91

Promoting interoperability

91

Improvement activities

40

Cost

77.16

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jerry.john@epiphanyderm.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Epiphany Dermatology PA

  • Dermatology Physician
  • Waco, TX
  • NPI 1043615263
  Medicare reassignment Care Compare group
• John David Miller, M.D.P.a.

  dba Mid-Cities Dermatology Clinic

  • Specialist
  • Bedford, TX
  • NPI 1467581439
  NPD
• R Todd Plott MD PA

  dba Dermatology Alliance - Keller

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1134426794
  NPD
• Academy Dermatologists Group LLC

  • Procedural Dermatology Physician
  • Tucson, AZ
  • NPI 1144588047
  NPD (past)

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1285377457",
    "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": "1615 HOSPITAL PKWY STE 306",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760225936",
            "telephone_number": "512-628-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "JERRY",
        "middle_name": "KULANGARA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-15",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisol Jimenez
• John a Hayes DDS PA
• John Barnett MD PA (Revive Men's Clinic)
• John David Miller, M.D.P.a. (Mid-Cities Dermatology Clinic)
• Elizabeth Mani John, MD
• Johnna Jones DO Facos PA
• Johnson & Collins Orthodontics
• Charles A Johnson, DC
• Doyle Johnson
• Grant D. Johnson, D.D.S., M.S.

• Physician Assistant in Bedford, TX
• Providers in Bedford, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.