Austin Dermatology Clinic, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

AUSTIN DERMATOLOGY CLINIC, PA

Practice address

11623 Angus Rd
Suite 25
Austin, TX 78759-4041

Phone

(512) 345-9411

Fax

(512) 345-0392

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael Howard Coverman, M.D.

Title

President

Phone

(512) 345-9411

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Michael H. Coverman, M.D. Other name

Locations

Practitioners 3

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

• Jennifer Jean Jordan, P.A.

  • Medical Physician Assistant
  • Austin, TX
  • NPI 1164534699
  NPD (past)
• Allison Leigh Martin, PA-C

  • Physician Assistant
  • Kenedy, TX
  • NPI 1154567212

  Dermatology

  NPD (past)
• Brooke Marie Stidham, PAC

  • Physician Assistant
  • Austin, TX
  • NPI 1134450497
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224633600000",
    "number": "1861501736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11623 ANGUS RD",
            "address_2": "SUITE 25",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594041",
            "telephone_number": "512-345-9411",
            "fax_number": "512-345-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11623 ANGUS RD",
            "address_2": "SUITE 25",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787594041",
            "telephone_number": "512-345-9411",
            "fax_number": "512-345-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUSTIN DERMATOLOGY CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-10-22",
        "status": "A",
        "authorized_official_last_name": "COVERMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-345-9411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF6572",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0096PM",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael H. Coverman, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.