NPIMap

Organization Active NPI

Westlake Dermatology, PA

  • Dermatology Physician
  • Houston, TX
National Provider Identifier
1437617255
Registry record updated Mar 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WESTLAKE DERMATOLOGY, PA
Practice address
2132 Bissonnet St
Houston, TX 77005-1508
Phone
(512) 615-2738
Fax
(281) 205-3503
NPI assigned
Mar 11, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2019

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

Authorized official

Name
Mr. Gregory A. Nikolaidis, MD
Title
Owner
Phone
(512) 328-3376

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X

Addresses

Primary practice location

2132 Bissonnet St
Houston, TX 77005-1508

Mailing address

8825 Bee Caves Rd Ste 100
Austin, TX 78746-4721
Phone (512) 328-3376

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040804000774 TX Part B Supplier - Clinic/Group Practice 6305817230 Receives reassigned benefits from 65 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Antonio, TX; Round Rock, TX; Marble Falls, TX; Lockhart, TX; Lakeway, TX; Houston, TX; Georgetown, TX; Dallas, TX…

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2186046Westlake Dermatology- W University2132 Bissonnet St Suite 200, Houston, TX 77005RegistrationOct 14, 2026

National Provider Directory

National Provider Directory
Tax ID family
Westlake Dermatology5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2132 Bissonnet St
Ste 200
Houston, TX 77005
Phone (281) 203-0600

3636 Westheimer Rd
Houston, TX 77027
Phone (832) 924-3300

2132 Bissonnet St
Houston, TX 77005
Phone (512) 615-2738

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552262400000",
    "number": "1437617255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8825 BEE CAVES RD STE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787464721",
            "telephone_number": "512-328-3376",
            "fax_number": "512-666-3767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2132 BISSONNET ST",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770051508",
            "telephone_number": "512-615-2738",
            "fax_number": "281-205-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTLAKE DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-11",
        "last_updated": "2019-03-11",
        "status": "A",
        "authorized_official_last_name": "NIKOLAIDIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-328-3376",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2019; 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.