Epiphany Dermatology of Minnesota, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

EPIPHANY DERMATOLOGY OF MINNESOTA, LLC

Practice address

2718 Ekko Ave
Albert Lea, MN 56007-1800

Phone

(507) 373-2270

Fax

(507) 373-0363

NPI assigned

Oct 13, 2006

Last updated

Jun 9, 2025By the provider in NPPES

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

Vice President

Phone

(512) 960-5760

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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 4

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.

• Robert James Zabel, D.O.

  • Dermatology Physician
  • Lakeville, MN
  • NPI 1649248162
  Medicare reassignment Care Compare group NPD
• Brian Gerard Zogg, MD

  • Dermatology Physician
  • Albert Lea, MN
  • NPI 1780681890
  Medicare reassignment Care Compare group NPD
• Sheila M Cavallaro, PAC

  • Dermatology Physician
  • Lakeville, MN
  • NPI 1154386001
  Medicare reassignment Care Compare group
• Kaitlin Zabel

  • Physician Assistant
  • Lakeville, MN
  • NPI 1164215539
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749427200000",
    "number": "1356431191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH RD. 2222, BLDG 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787302309",
            "telephone_number": "512-628-0465",
            "fax_number": "512-628-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2718 EKKO AVE",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560071800",
            "telephone_number": "507-373-2270",
            "fax_number": "507-373-0363"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20520 Keokuk Ave Ste 104",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550446085",
            "country_code": "US",
            "telephone_number": "952-469-5033",
            "fax_number": "952-469-5069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF MINNESOTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "512-960-5760"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Albert Lea, MN
• Providers in Albert Lea, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.