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CALYX DERMATOLOGY LLC
NPI 1003657198
Dermatology - MOHS-Micrographic Surgery in Albuquerque, NM

Active since June 04, 2024CLIA 32D2312724 · Certificate of Compliance
612 ENCINO PL NE, ALBUQUERQUE, NM 87102(240) 367-2980 Get Directions Write a Review

NPPES record last updated: July 25, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 25, 2024, Jun 4, 2024 (2 updates tracked since 2024).

About Calyx Dermatology Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CALYX DERMATOLOGY LLC (NPI 1003657198) is a healthcare organization registered as a mohs-micrographic surgery in Albuquerque, New Mexico and active in the NPI registry since June 2024. The organization holds a CLIA Certificate of Compliance certificate valid through August 28, 2027 and lists Catherine Tchanque-fossuo, Dermatologist/mohs Surgeon, as its authorized official.

NPPES Registry Identity

NPI1003657198
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameCALYX DERMATOLOGY LLC
Location Address612 ENCINO PL NEAlbuquerque, NM 87102-2602
Mailing Address5863 Mafraq Ave NwAlbuquerque, NM 87114-6071 · (240) 367-2980
Phone(240) 367-2980
Organization SubpartNo
Authorized OfficialCatherine Tchanque-fossuoDermatologist/mohs Surgeon · (240) 367-2980
Enumeration DateJune 4, 2024
Last NPPES UpdateJuly 25, 20242 updates tracked since enumeration
NPPES CertifiedJuly 25, 2024
✔ NPI 1003657198 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
Also ListedDermatologyTaxonomy 207N00000X
612 ENCINO PL NE, Albuquerque, NM 87102
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Calyx Dermatology Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Calyx Dermatology LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Catherine Tchanque-Fossuo, M.D., M.S.
Dermatology
NPI 1558588830
10151 MONTGOMERY BLVD NE BLDG 1
Albuquerque, NM 87111
(505) 273-5054
✔ PECOS✔ Accepts Medicare6.7 mi
Jennifer Otero, FNP-BC
Nurse Practitioner
NPI 1881387736
8650 ALAMEDA BLVD NE STE 101E
Albuquerque, NM 87122
(505) 255-1866
✔ PECOS✔ Accepts Medicare8.2 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 32D2312724

Calyx Dermatology · Albuquerque, NM
Active · expires Aug 28, 2027
CLIA Number32D2312724
Laboratory TypePhysician Office
Certificate Effective DateAugust 29, 2025
Certificate Expiration DateAugust 28, 2027
Laboratory DirectorCatherine Tchanque-Fossuo
Laboratory Phone(505) 273-8007
Laboratory LocationCalyx Dermatology612 Encino Place NE, Albuquerque, NM 87102
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Calyx Dermatology LLC's NPI number?

The NPI number for Calyx Dermatology LLC is 1003657198. It was assigned to this organization in the NPPES registry on June 4, 2024.

Where is Calyx Dermatology LLC located?

Calyx Dermatology LLC is located at 612 Encino Pl NE, Albuquerque, NM 87102. The listed phone number is (240) 367-2980.

What is Calyx Dermatology LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Calyx Dermatology LLC enrolled in Medicare?

Yes. Calyx Dermatology LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Calyx Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Calyx Dermatology LLC, in Dermatology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Calyx Dermatology LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 32D2312724) is associated with this NPI, valid through August 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Calyx Dermatology LLC was last updated on July 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.