NPIMap

Organization Active NPI

Westlake Dermatology, PA

  • Dermatology Physician
  • Lakeway, TX
National Provider Identifier
1891029476
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
WESTLAKE DERMATOLOGY, PA
Practice address
401 RR 620 N
Suite 200
Lakeway, TX 78734-3910
Phone
(512) 610-0549
Fax
(512) 306-0222
NPI assigned
Sep 29, 2009
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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

Authorized official

Name
Gregory Nikolaidis, MDNPI 1033181813
Title
Owner/President
Phone
(512) 328-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X TX Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

401 RR 620 N
Suite 200
Lakeway, TX 78734-3910

Mailing address

8825 Bee Caves Rd Ste 111
Austin, TX 78746-4720
Phone (512) 328-3376

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040804000774 TX Part B Supplier - Clinic/Group Practice 6305817230 Receives reassigned benefits from 65 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Antonio, TX; Round Rock, TX; Marble Falls, TX; Lockhart, TX; Lakeway, TX; Houston, TX; Georgetown, TX; Dallas, TX…

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Westlake Dermatology5 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

164 Belterra Village Way
Ste Y700
Austin, TX 78737
Phone (512) 610-3376

6836 Bee Caves Rd
Ste 111
Austin, TX 78746
Phone (512) 327-4243

1760 Round Rock Ave
Round Rock, TX 78681
Phone (512) 583-3376

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1891029476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8825 BEE CAVES RD STE 111",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787464720",
            "telephone_number": "512-328-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 RR 620 N",
            "address_2": "SUITE 200",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787343910",
            "telephone_number": "512-610-0549",
            "fax_number": "512-306-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTLAKE DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-29",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "NIKOLAIDIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "512-328-3376",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeway, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; 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.