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EPIPHANY DERMATOLOGY PA
NPI 1043615263
Dermatology in Waco, TX

Active since October 30, 2014CLIA Certified · 2 labs
7106 SANGER AVENUE, WACO, TX 76712(254) 537-1265(254) 537-1310 Get Directions Write a Review

NPPES record last updated: July 21, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 21, 2023, Sep 23, 2016 (2 updates tracked since 2016).

About Epiphany Dermatology Pa NPPES

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

EPIPHANY DERMATOLOGY PA (NPI 1043615263) is a healthcare organization registered as a dermatology in Waco, Texas and active in the NPI registry since October 2014. The organization holds 2 active CLIA laboratory certificates and lists Gheorghe Pusta, Ceo, as its authorized official.

NPPES Registry Identity

NPI1043615263
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameEPIPHANY DERMATOLOGY PA
Location Address7106 SANGER AVENUEWaco, TX 76712-3928
Mailing Address7300 Ranch Road 2222, Bldg 1, Ste 200Austin, TX 78730-3255 · (512) 628-0465 · Fax (512) 628-0468
Phone(254) 537-1265
Fax(254) 537-1310
Organization SubpartNo
Authorized OfficialGheorghe PustaCeo · (512) 628-0465
Enumeration DateOctober 30, 2014
Last NPPES UpdateJuly 21, 20232 updates tracked since enumeration
NPPES CertifiedJuly 21, 2023
✔ NPI 1043615263 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in TX · Q1815
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X · License Q1815 (TX)
Also ListedClinic/Center · RadiologyTaxonomy 261QR0200X
7106 SANGER AVENUE, Waco, TX 76712
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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 MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 45D2203170

Epiphany Dermatology, PA · Waco, TX
Active · expires Apr 17, 2028
CLIA Number45D2203170
Laboratory TypePhysician Office
Certificate Effective DateApril 18, 2026
Certificate Expiration DateApril 17, 2028
Laboratory DirectorAlyn D. Hatter
Laboratory Phone(254) 537-1265
Laboratory LocationEpiphany Dermatology, PA7106 Sanger Ave, Waco, TX 76712
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 45D2311168

Epiphany Dermatology, PA · Hillsboro, TX
Active · expires Sep 16, 2026
CLIA Number45D2311168
Laboratory TypePhysician Office
Certificate Effective DateSeptember 17, 2024
Certificate Expiration DateSeptember 16, 2026
Laboratory DirectorJerry K. John
Laboratory Phone(254) 537-1265
Laboratory LocationEpiphany Dermatology, PA1323 E Franklin, Suite 103, Hillsboro, TX 76645
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Epiphany Dermatology PA's NPI number?

The NPI number for Epiphany Dermatology PA is 1043615263. It was assigned to this organization in the NPPES registry on October 30, 2014.

Where is Epiphany Dermatology PA located?

Epiphany Dermatology PA is located at 7106 Sanger Avenue, Waco, TX 76712. The listed phone number is (254) 537-1265.

What is Epiphany Dermatology PA's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Epiphany Dermatology PA hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Epiphany Dermatology PA accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 3 other insurers list Epiphany Dermatology PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Epiphany Dermatology PA was last updated on July 21, 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.