DERMATOLOGY AND PLASTIC SURGERY SPECIALISTS PLLC
NPI 1043096365
Plastic Surgery in Southlake, TX

Q: What is Dermatology And Plastic Surgery Specialists PLLC's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Active since September 01, 2023

245 W STATE HIGHWAY 114 SUITE 100, SOUTHLAKE, TX 76092(817) 912-1200 Get Directions Write a Review

NPPES record last updated: September 1, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Dermatology And Plastic Surgery Specialists Pllc NPPES

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

DERMATOLOGY AND PLASTIC SURGERY SPECIALISTS PLLC (NPI 1043096365), doing business as Plastic Surgery Specialists, is a healthcare organization registered as a plastic surgery in Southlake, Texas and active in the NPI registry since September 2023. The organization lists Jason Kyle Potter, Physician, as its authorized official.

NPPES Registry Identity

NPI1043096365

Entity TypeOrganization

Primary Taxonomy208200000X

Legal Business NameDERMATOLOGY AND PLASTIC SURGERY SPECIALISTS PLLC

Location Address245 W STATE HIGHWAY 114 SUITE 100Southlake, TX 76092

Mailing Address245 W State Highway 114 Suite 100Southlake, TX 76092 · (817) 912-1200

Phone(817) 912-1200

Organization SubpartYes

Authorized OfficialJason Kyle PotterPhysician · (214) 930-6588

Enumeration DateSeptember 1, 2023

NPPES CertifiedSeptember 1, 2023

✔ NPI 1043096365 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208200000X

Definition

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

245 W STATE HIGHWAY 114 SUITE 100, Southlake, TX 76092

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Other Names 1

Doing Business AsPlastic Surgery Specialists

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE 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)

Dermatology And Plastic Surgery Specialists Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Dermatology And Plastic Surgery Specialists PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Tarik Madni, M.D.

Plastic and Reconstructive Surgery

NPI 1851735922

245 W STATE HIGHWAY 114 STE 100
Southlake, TX 76092

(817) 912-1200

✔ PECOS✔ Accepts MedicareSame address

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

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 Dermatology And Plastic Surgery Specialists PLLC's NPI number?

The NPI number for Dermatology And Plastic Surgery Specialists PLLC is 1043096365. It was assigned to this organization in the NPPES registry on September 1, 2023. The provider is doing business as Plastic Surgery Specialists.

Where is Dermatology And Plastic Surgery Specialists PLLC located?

Dermatology And Plastic Surgery Specialists PLLC is located at 245 W State Highway 114 Suite 100, Southlake, TX 76092. The listed phone number is (817) 912-1200.

What is Dermatology And Plastic Surgery Specialists PLLC's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Is Dermatology And Plastic Surgery Specialists PLLC enrolled in Medicare?

Yes. Dermatology And Plastic Surgery Specialists PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dermatology And Plastic Surgery Specialists PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Plastic and Reconstructive Surgery) reassigns their Medicare billing to Dermatology And Plastic Surgery Specialists PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Dermatology And Plastic Surgery Specialists PLLC was last updated on September 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.