NPIMap

Organization Active NPI

Westlake Dermatology PA

Doing business as Westlake Dermatology

  • Dermatology Physician
  • Round Rock, TX
National Provider Identifier
1477678993
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WESTLAKE DERMATOLOGY PA
Doing business as
Westlake Dermatology
Practice address
1760 Round Rock Ave
Round Rock, TX 78681-4217
Phone
(512) 583-3376
Fax
(512) 306-0222
NPI assigned
Mar 21, 2007
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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

Authorized official

Name
Dr. Gregory Nikolaidis, MDNPI 1033181813
Title
President
Phone
(512) 328-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X TX Primary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X TX

Addresses

Primary practice location

1760 Round Rock Ave
Round Rock, TX 78681-4217

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
00591TOtherTXBCBS OF TEXAS GROUP#
211724401MedicaidTX

Other names 1

  • Westlake Dermatology Doing business as

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.

National Provider Directory

National Provider Directory

Locations

3800 N Lamar Blvd
Ste 155
Austin, TX 78756
Phone (512) 617-9200

2201 Onion Creek Pkwy
Austin, TX 78747
Phone (512) 649-3376

200 N Lakeline Blvd
Cedar Park, TX 78613

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

800 S US Highway 281
Marble Falls, TX 78654
Phone (830) 693-4800

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1477678993",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 ROUND ROCK AVE",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814217",
            "telephone_number": "512-583-3376",
            "fax_number": "512-306-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTLAKE DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "NIKOLAIDIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-328-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS GROUP#",
            "identifier": "00591T",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211724401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westlake Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Rock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.