Active NPI
Epiphany Dermatology of Arizona, LLC
- Dermatology Physician
- Peoria, AZ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- EPIPHANY DERMATOLOGY OF ARIZONA, LLC
- Practice address
- 7767 W Deer Valley Rd
Suite 140
Peoria, AZ 85382-2103 - Phone
- (623) 487-3003
- Fax
- (623) 487-0952
- NPI assigned
- Aug 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Gheorghe Pusta
- Title
- Ceo
- Phone
- (512) 628-0465
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
7767 W Deer Valley Rd
Suite 140
Peoria, AZ 85382-2103
Mailing address
7300 Ranch Rd. 2222, BLDG 1, Ste 200
Austin, TX 78730
Phone (512) 628-0465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040402000307 | AZ | Part B Supplier - Clinic/Group Practice | 9830181361 |
Receives reassigned benefits from 44 practitioners Practice locations: Buckeye, AZ; Tucson, AZ; Sierra Vista, AZ; Phoenix, AZ; Peoria, AZ; Avondale, AZ |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D0957147 | Epiphany Dermatology of Arizona, LLC | Compliance | Dec 9, 2027 |
National Provider Directory
National Provider DirectoryLocations
10750 W McDowell Rd
Ste C305
Avondale, AZ 85392
Phone (623) 440-1633
20800 W Market St
Ste 111
Buckeye, AZ 85396
Phone (623) 624-7200
7767 W Deer Valley Rd
Ste 140
Peoria, AZ 85382
Phone (623) 487-3003
2525 W Carefree Hwy
Ste 144
Phoenix, AZ 85085
Phone (623) 487-3003
6648 E Carondelet Dr
Tucson, AZ 85710
Phone (520) 886-8151
Practitioners & affiliated clinicians
Practitioners 45
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": "1155945600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701907200000",
"number": "1457465858",
"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": "78730",
"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": "7767 W DEER VALLEY RD",
"address_2": "SUITE 140",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853822103",
"telephone_number": "623-487-3003",
"fax_number": "623-487-0952"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EPIPHANY DERMATOLOGY OF ARIZONA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-19",
"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": "CEO",
"authorized_official_telephone_number": "512-628-0465",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- 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.