Epiphany Dermatology of Oklahoma, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

EPIPHANY DERMATOLOGY OF OKLAHOMA, LLC

Practice address

10115 E 80TH St Ste a
Tulsa, OK 74133-3421

Phone

(512) 628-0465

Fax

(512) 628-0468

NPI assigned

Apr 13, 2017

Organization subpart

No

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

Authorized official

Name

Gheorghe Pusta

Title

Ceo

Phone

(512) 628-0465

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea Jurgens, MD, MPH

  • Dermatology Physician
  • Muskogee, OK
  • NPI 1467806323

  Dermatology, OK

  Medicare reassignment Care Compare group NPD
• Cory B Maughan, D.O.

  • MOHS-Micrographic Surgery Physician
  • Providence, UT
  • NPI 1598086720

  Dermatology, OK

  Medicare reassignment Care Compare group NPD
• Johnson N Mwangi, PA-C

  • Physician Assistant
  • Tyler, TX
  • NPI 1578748505

  OK

  Medicare reassignment Care Compare group NPD
• Ashlee Lauren Culver, MD

  • Dermatology Physician
  • Bozeman, MT
  • NPI 1659833986

  OK

  Medicare reassignment Care Compare group
• Feroza Thompson, PA

  • Physician Assistant
  • Mesquite, NV
  • NPI 1891940698

  OK

  Medicare reassignment Care Compare group
• Grant Michael Dietz, PA-C

  • Physician Assistant
  • Tulsa, OK
  • NPI 1538943618

  OK

  Medicare reassignment NPD
• Michael Tracey, MD, FAAD

  • Dermatology Physician
  • Fort Sill, OK
  • NPI 1023505971

  Dermatology, OK

  Medicare reassignment NPD
• Cary Daniel Chisholm, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Waco, TX
  • NPI 1346498755

  OK

  Medicare reassignment NPD

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

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1801320106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH RD. 2222, BLDG 1, STE 200",
            "address_2": "SUITE 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": "10115 E 80TH ST STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741333421",
            "telephone_number": "512-628-0465",
            "fax_number": "512-628-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF OKLAHOMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-13",
        "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": "CEO",
        "authorized_official_telephone_number": "512-628-0465"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Envida Rehabilitation LLC
• Melissa Enwusoyele Goodluck, RN
• Brett M Enyart, O.D.
• Enzo Neurotech, PLLC
• Ep Healthcare Transport LLC
• Patti Suzanne Epley, MSW
• Samuel Epp
• Jane Epperley, PHD
• Ronnie Epperly, LPC
• Kimberly D Epperson, FSP

• All providers in Tulsa, OK
• Dermatology Physician in Oklahoma

• 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.