Epiphany Dermatology of New Mexico, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

88-97 Issued in NM

Legal business name

EPIPHANY DERMATOLOGY OF NEW MEXICO, LLC

Practice address

5600 Eubank Blvd NE
Ste 110
Albuquerque, NM 87111-1519

Phone

(512) 628-0465

Fax

(512) 628-0468

NPI assigned

Dec 31, 2015

Last updated

Dec 7, 2023By 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

Manager

Phone

(512) 628-0465

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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 58

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.

• Sarah Catherine Allan, NP

  • Family Nurse Practitioner
  • Farmington, NM
  • NPI 1245871623
  Medicare reassignment Care Compare group NPD
• James H Auerbach, MD

  • Dermatology Physician
  • Santa Fe, NM
  • NPI 1154426427
  Medicare reassignment Care Compare group NPD
• Lisa K Bushnell, C.F.N.P.

  • Family Nurse Practitioner
  • Taos, NM
  • NPI 1174524912
  Medicare reassignment Care Compare group NPD
• Leslie J Havard, MD

  • Dermatology Physician
  • Taos, NM
  • NPI 1891803920
  Medicare reassignment Care Compare group NPD
• James D Kerner, M.D., PHD

  • Dermatology Physician
  • Las Cruces, NM
  • NPI 1962429563

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Ethan C Levin, M.D.

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1326332123
  Medicare reassignment Care Compare group NPD
• Janice F Moranz, MD

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1295821098
  Medicare reassignment Care Compare group NPD
• Thu Thanh Nguyen, FNP

  • Family Nurse Practitioner
  • Edgewood, NM
  • NPI 1205459369
  Medicare reassignment Care Compare group NPD
• Amanda Pollat

  • Nurse Practitioner
  • Roswell, NM
  • NPI 1780404558

  Single Specialty

  Medicare reassignment Care Compare group NPD
• James Robb, FNP-C

  • Nurse Practitioner
  • Farmington, NM
  • NPI 1801671631
  Medicare reassignment Care Compare group NPD
• Ronald Rovner, MD

  • Dermatology Physician
  • Santa Fe, NM
  • NPI 1649388422
  Medicare reassignment Care Compare group NPD
• Luis Antonio Sardina Pena, M.D

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1811379274

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1447615760",
    "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": "787303255",
            "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": "5600 EUBANK BLVD NE",
            "address_2": "STE 110",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871111519",
            "telephone_number": "512-628-0465",
            "fax_number": "512-628-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF NEW MEXICO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "512-628-0465"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NM",
            "license": "88-97",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mikaela Epaloose
• Epc NM Aco LLC
• Epic Minds Therapy NM LLC
• Epic Pathway LLC
• Epidaurus (Amity Foundation)
• Epiphany Mental Health Counseling
• Epmed, PA (New Mexico Pain Center of Albuquerq)
• Epoch Behavioral Healthcare, Inc.
• Kaylee R Epperson
• Christine Elaine Epstein, MA, CCC-A

• Dermatology Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Dermatology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.