Organization Active NPI

Cinco Ranch Dermatology, P.a.

  • Dermatology Physician
  • Katy, TX
National Provider Identifier
1780926733
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
P4855 Issued in TX
Legal business name
CINCO RANCH DERMATOLOGY, P.A.
Practice address
23050 Westheimer Pkwy
Katy, TX 77494-3596
Phone
(281) 394-9500
Fax
(281) 394-5350
NPI assigned
Mar 17, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Authorized official

Name
Dr. Kelly B Conner, M.D.NPI 1801039722
Title
Owner / Authorized Official
Phone
(281) 394-9500

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X P4855 TX Primary

Addresses

Primary practice location

23050 Westheimer Pkwy
Katy, TX 77494-3596

Mailing address

23050 Westheimer Pkwy
Katy, TX 77494-3596
Phone (281) 394-9500

Other names 1

  • Cinco Ranch Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130910000553 TX Part B Supplier - Clinic/Group Practice 0345484598 Receives reassigned benefits from 6 practitioners
Practice locations: Katy, 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
45D2066539Cinco Ranch Dermatology, PA23050 Westheimer Pkwy, Katy, TX 77494Provider-performed microscopySep 26, 2027

National Provider Directory

National Provider Directory

Locations

2643 Commercial Center Blvd
Ste B360
Katy, TX 77494
Phone (281) 891-3690

23050 Westheimer Pkwy
Katy, TX 77494
Phone (281) 394-9500

23501 Cinco Ranch Blvd
Ste H120609
Katy, TX 77494

Practitioners & affiliated clinicians

Practitioners 10

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": "1363478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620259200000",
    "number": "1780926733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23050 WESTHEIMER PKWY",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774943596",
            "telephone_number": "281-394-9500",
            "fax_number": "281-394-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23050 WESTHEIMER PKWY",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774943596",
            "telephone_number": "281-394-9500",
            "fax_number": "281-394-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CINCO RANCH DERMATOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-17",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "281-394-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "P4855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cinco Ranch Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cinco Ranch Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Katy, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; 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.