Magnolia Dermatology of Frisco PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MAGNOLIA DERMATOLOGY OF FRISCO PLLC

Practice address

13192 Dallas Pkwy Ste 620
Frisco, TX 75033-4248

Phone

(972) 668-3376

Fax

(972) 668-7546

NPI assigned

Mar 11, 2022

Organization subpart

No

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

Authorized official

Name

Carla A. Gustovich, MDNPI 1003981044

Title

President

Phone

(972) 668-3376

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DJEHCD

Practitioners 2

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.

• Carla Gustovich, MD

  • Dermatology Physician
  • Frisco, TX
  • NPI 1003981044
  Medicare reassignment Care Compare group NPD Authorized official
• Rachel Heather Quinby-Graves, M.D.

  • Dermatology Physician
  • Plano, TX
  • NPI 1053337873
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1646956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1821746660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13192 DALLAS PKWY STE 620",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750334248",
            "telephone_number": "972-668-3376",
            "fax_number": "972-668-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13192 DALLAS PKWY STE 620",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750334248",
            "telephone_number": "972-668-3376",
            "fax_number": "972-668-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DERMATOLOGY OF FRISCO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "GUSTOVICH",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-668-3376",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Ogechukwu Maduh, PMHNP
• Exalander Samuel Magallan III, MS, LAT, ATC
• Rhea Paige Magee, OD
• Magellan Provider Services, P.a.
• Maggie Tran OD PLLC (Illume eyecare)
• Magnolia Pediatrics (All Star Pediatrics)
• Meredith L Magruder, LPC
• Ryan Thomas Mahady
• Mahaffey JL Enterprises, Inc. (Homewatch CareGivers of Collin County)
• Neelu Mahajan, PA - C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.