NPIMap

Organization Active NPI

Dermatology Associates of West Texas, LLP

  • Dermatology Physician
  • Lubbock, TX
National Provider Identifier
1679704530
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
J6653 M5588 Issued in TX
Legal business name
DERMATOLOGY ASSOCIATES OF WEST TEXAS, LLP
Practice address
2202 Ithaca Ave
Lubbock, TX 79410-1332
Phone
(806) 797-1202
Fax
(806) 797-4854
NPI assigned
Jul 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Brent R. Paulger, M.D.NPI 1093701468
Title
Partner
Phone
(806) 797-1202

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X J6653 M5588 TX Primary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0101X J6653 M5588 TX
Dermatopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ND0900X J6653 M5588 TX

Addresses

Primary practice location

2202 Ithaca Ave
Lubbock, TX 79410-1332

Mailing address

2202 Ithaca Ave
Lubbock, TX 79410-1332
Phone (806) 797-1202

Other names 1

  • Paulger & Wisniewski Dermatology, LLP Former legal business name

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address kwisniewski@directaddress.net Health Information Exchange (HIE)
Direct Messaging Address bpaulger@directaddress.net Health Information Exchange (HIE)
Direct Messaging Address lmoyers@directaddress.net Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100104000221 TX Part B Supplier - Clinic/Group Practice 7911048632 Receives reassigned benefits from 8 practitioners
Practice locations: Denver City, TX; Lubbock, TX; Snyder, TX

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
45D0936943Dermatology Associates of West Texas, LLP2202 Ithaca, Lubbock, TX 79410ComplianceMar 29, 2028

National Provider Directory

National Provider Directory

Locations

2310 Indiana Ave
Lubbock, TX 79410
Phone (806) 795-9777

2202 Ithaca Ave
Ste C
Lubbock, TX 79410
Phone (806) 797-1202

Interoperability endpoints

  • Direct secure messaging: bpaulger@directaddress.net
  • Direct secure messaging: kwisniewski@directaddress.net

Practitioners & affiliated clinicians

Practitioners 11

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": "1248652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1679704530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 ITHACA AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101332",
            "telephone_number": "806-797-1202",
            "fax_number": "806-797-4854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 ITHACA AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101332",
            "telephone_number": "806-797-1202",
            "fax_number": "806-797-4854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF WEST TEXAS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-27",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "PAULGER",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "806-797-1202",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "J6653  M5588",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "TX",
            "license": "J6653  M5588",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": "J6653  M5588",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwisniewski@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Message",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "2202 Ithaca Ave",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794101332",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bpaulger@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Message",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "2202 Ithaca Ave",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794101332",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lmoyers@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "Direct Message",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "2202 Ithaca Ave",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794101332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Paulger & Wisniewski Dermatology, LLP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.