Epiphany Dermatology of Montana, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

EPIPHANY DERMATOLOGY OF MONTANA, PLLC

Practice address

24 E Broadway St
Butte, MT 59701-9334

Phone

(406) 723-7272

Fax

(406) 723-3328

NPI assigned

Sep 10, 2019

Last updated

Dec 7, 2023By the provider in NPPES

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

Director/Managing Employee

Phone

(512) 960-5760

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MT

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 26

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.

• Jonathan L Bingham, MD

  • MOHS-Micrographic Surgery Physician
  • Great Falls, MT
  • NPI 1821074295
  Medicare reassignment Care Compare group NPD
• Dixon Lee Robison, M.D.

  • Dermatology Physician
  • Butte, MT
  • NPI 1003900457
  Medicare reassignment Care Compare group NPD
• Shannon Setzer, M.D.

  • Dermatology Physician
  • Bozeman, MT
  • NPI 1639355928
  Medicare reassignment Care Compare group NPD
• Leslie Ellen Stapp, DO

  • Dermatology Physician
  • Great Falls, MT
  • NPI 1154380020
  Medicare reassignment Care Compare group NPD
• Alyson Anne Thede, MD

  • Dermatology Physician
  • Bozeman, MT
  • NPI 1003344862
  Medicare reassignment Care Compare group NPD
• Nicole Leigh Wellman Donester, M.D.

  • Dermatology Physician
  • Great Falls, MT
  • NPI 1689909566
  Medicare reassignment Care Compare group NPD
• Jeffrey M Williams, M.D.

  • Dermatology Physician
  • Bozeman, MT
  • NPI 1538371133
  Medicare reassignment Care Compare group NPD
• Cory B Maughan, D.O.

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

  Dermatology, MT

  Medicare reassignment Care Compare group NPD
• Logan Skelley, M.D.

  • MOHS-Micrographic Surgery Physician
  • Coralville, IA
  • NPI 1851710727

  Dermatology, MT

  Medicare reassignment Care Compare group NPD
• Latha Sree Vellanki, M.D.

  • Dermatology Physician
  • Tucson, AZ
  • NPI 1346332640

  MT

  Medicare reassignment Care Compare group NPD
• Katie Melissa Kaye Brown, PA

  • Physician Assistant
  • Great Falls, MT
  • NPI 1154602431
  Medicare reassignment Care Compare group
• Kasie D Cooper, PA-C

  • Physician Assistant
  • Helena, MT
  • NPI 1598356164
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1902455074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH RD. 2222, BLDG 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78730",
            "telephone_number": "512-628-0465",
            "fax_number": "512-233-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 E BROADWAY ST",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597019334",
            "telephone_number": "406-723-7272",
            "fax_number": "406-723-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF MONTANA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-10",
        "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": "DIRECTOR/MANAGING EMPLOYEE",
        "authorized_official_telephone_number": "512-960-5760"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Ellis, LCSW
• William Bruce Ellis, M.D.
• Empres at Butte, LLC (Butte Health and Rehabilitation Center)
• Dawn M English, LCSW AND LCPC
• Samantha Mikayla Enloe, OTD, OTR/L
• Jaden Howard Erwin, DDS, MSD
• Emily Evans, LCSW
• Mathew Ryan Evans, LCSW
• Evergreen at Butte, L.L.C. (Evergreen Butte Health and REhabilitation Center)
• Constance Marie Everly, RPH

• Dermatology Physician in Butte, MT
• Providers in Butte, MT by specialty
• Dermatology Physician in Montana

• 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.