NPIMap

Organization Active NPI

Epiphany Dermatology of Kansas, LLC

  • Dermatology Physician
  • Overland Park, KS
National Provider Identifier
1710444500
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EPIPHANY DERMATOLOGY OF KANSAS, LLC
Practice address
8505 College Blvd
Overland Park, KS 66210-1836
Phone
(913) 541-3230
NPI assigned
Feb 27, 2019
Last updated
Dec 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Gheorghe Pusta
Title
Executive Director
Phone
(512) 628-0465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

8505 College Blvd
Overland Park, KS 66210-1836

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 KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191122001694 KS Part B Supplier - Clinic/Group Practice 4082046412 Receives reassigned benefits from 15 practitioners
Practice locations: Leawood, KS; Mission Woods, KS; Overland Park, KS; Shawnee, KS

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
17D0677930Epiphany Dermatology of Kansas, LLC8505 College Blvd, Overland Park, KS 66210ComplianceJul 6, 2027

National Provider Directory

National Provider Directory

Locations

10600 Quivira Rd
Ste 430
Overland Park, KS 66215
Phone (913) 541-3230

8505 College Blvd
Overland Park, KS 66210
Phone (913) 541-3230

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1710444500",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8505 COLLEGE BLVD",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662101836",
            "telephone_number": "913-541-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF KANSAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-27",
        "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": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "512-628-0465"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

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.

Verify at the official NPI Registry.