Dermatology Associates of West Texas, LLP

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

Last updated

May 15, 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

Brent R. Paulger, M.D.NPI 1093701468

Title

Partner

Phone

(806) 797-1202

Specialties & licenses 3

Addresses

Other names 1

• Paulger & Wisniewski Dermatology, LLP Former legal business name

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Interoperability endpoints

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

Practitioners 11

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.

• Brent R. Paulger, M.D.

  • Dermatology Physician
  • Lubbock, TX
  • NPI 1093701468
  Medicare reassignment Care Compare group NPD Authorized official
• Rachel Layne Mitchell, PA-C

  • Physician Assistant
  • Lubbock, TX
  • NPI 1952184301
  Medicare reassignment Care Compare group NPD
• Lisa Marie Moyers

  • Family Nurse Practitioner
  • Lubbock, TX
  • NPI 1881179190
  Medicare reassignment Care Compare group NPD
• Ashley Sturgeon, MD

  • Dermatology Physician
  • Lubbock, TX
  • NPI 1285955492
  Medicare reassignment Care Compare group NPD
• Keith Wayne Wisniewski, M.D.

  • Dermatology Physician
  • Lubbock, TX
  • NPI 1588792741
  Medicare reassignment Care Compare group NPD
• Meredith Gavin Pham, MD

  • Dermatology Physician
  • Woodland, CA
  • NPI 1477176246

  TX

  Medicare reassignment Care Compare group NPD
• Amanda Bell, PA-C

  • Physician Assistant
  • Lubbock, TX
  • NPI 1487030201
  Medicare reassignment Care Compare group
• Kristin Nicole O'Banion, APRN, FNP-C

  • Nurse Practitioner
  • Lubbock, TX
  • NPI 1689397366
  Medicare reassignment Care Compare group
• Frank M Ryburn III, MD

  • Ophthalmology Physician
  • Lubbock, TX
  • NPI 1295833614
  NPD
• Stephanie Elaine Gerhart, FNP

  • Nurse Practitioner
  • Lubbock, TX
  • NPI 1861173635

  Dermatology

  NPD (past)
• Bryan T O'Neall, PA

  • Physician Assistant
  • Lubbock, TX
  • NPI 1346223401
  NPD (past)

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"
        }
    ]
}

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• Dermatology Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Dermatology Physician in Texas

• 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.