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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: October 18, 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
Open in Google Maps ↗

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 ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

103

Medicare enrollment records show 103 clinicians reassign Medicare billing to Epiphany Dermatology PA, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 6

Dermatology87
Nurse Practitioner11
Pathology2
Cardiovascular Disease (Cardiology)1
Interventional Radiology1
Micrographic Dermatologic Surgery (MDS)1

Nearest to this location (20)

See all 103
Michael Hatch, M.D.
Dermatology
NPI 1831551092
7106 SANGER RD
Waco, TX 76712
(542) 537-1265
✔ PECOS✔ Accepts MedicareSame address
Cary Chisholm, M.D.
Pathology
NPI 1346498755
601 W HWY 6 SUITE 111
Waco, TX 76710
(254) 752-9621
✔ PECOS✔ Accepts Medicare0.3 mi
James Mason, MD
Dermatology
NPI 1699763375
405 LONDONDERRY STE 205
Waco, TX 76712
(254) 772-9004
✔ PECOS✔ Accepts Medicare0.3 mi
Amanda Dibenedetto, FNP - C
Nurse Practitioner
NPI 1972810976
4513 WILLIAMS DR
Georgetown, TX 78633
(512) 930-3909
✔ PECOS✔ Accepts Medicare65 mi
Mary Evers, DO
Dermatology
NPI 1053533026
1900 SCENIC DR STE 2208
Georgetown, TX 78626
(512) 868-9800
✔ PECOS✔ Accepts Medicare68 mi
Terry Jones, MD
Dermatology
NPI 1821078387
1707 BROADMOOR DR SUITE 100
Bryan, TX 77802
(979) 776-7767
✔ PECOS✔ Accepts Medicare78 mi
Yasser Albahrani, M.D.
Dermatology
NPI 1427284710
2805 PRINCE GEORGE AVE
Desoto, TX 75115
(214) 269-3326
✔ PECOS✔ Accepts Medicare80 mi
Boris Ioffe, D.O.
Dermatology
NPI 1598949646
706 W CENTER ST
Duncanville, TX 75116
(972) 780-0707
✔ PECOS✔ Accepts Medicare80 mi
David Grice, DO
Dermatology
NPI 1538279237
3155 S CARRIER PKWY
Grand Prairie, TX 75052
(972) 263-5064
✔ PECOS✔ Accepts Medicare82 mi
Douglas Miller, MD
Dermatology
NPI 1881622405
1500 S MAIN ST
Fort Worth, TX 76104
(817) 921-3431
✔ PECOS84 mi
Edward Zabawski, D.O.
Dermatology
NPI 1386614733
1400 S MAIN ST STE 501
Fort Worth, TX 76104
(817) 702-1100
✔ PECOS✔ Accepts Medicare84 mi
Mojahed Mohammad K Shalabi, MD
Dermatology
NPI 1205586781
1400 8TH AVE
Fort Worth, TX 76104
(817) 922-4535
✔ PECOS✔ Accepts Medicare84 mi
Mary Zieglschmid Adams, M.D.
Dermatology
NPI 1508811779
801 ROAD TO SIX FLAGS WEST STE 139
Arlington, TX 76012
(817) 265-1356
✔ PECOS✔ Accepts Medicare85 mi
Jun Long, MD, PHD
Dermatology
NPI 1053992495
1001 N WALDROP DR STE 402
Arlington, TX 76012
(817) 265-1356
✔ PECOS✔ Accepts Medicare85 mi
Armineh Kajoian, M.D.
Pathology
NPI 1790789154
7801 N LAMAR BLVD STE D8182
Austin, TX 78752
(512) 868-3376
✔ PECOS✔ Accepts Medicare86 mi
Melody Vander Straten, MD
Dermatology
NPI 1730151549
5145 N FM 620 RANCH ROAD, BLDG I
Austin, TX 78732
(512) 681-5900
✔ PECOS✔ Accepts Medicare88 mi
Samantha Black, MD
Dermatology
NPI 1891375465
1615 HOSPITAL PKWY STE 306
Bedford, TX 76022
(817) 684-5100
✔ PECOS✔ Accepts Medicare91 mi
Jorge Roman, M.D.
Dermatology
NPI 1851824825
1615 HOSPITAL PKWY STE 306
Bedford, TX 76022
(817) 684-5100
✔ PECOS✔ Accepts Medicare91 mi
Thuy Mai Vu, NP
Nurse Practitioner
NPI 1225531528
2704 N GALLOWAY AVE STE 101
Mesquite, TX 75150
(972) 288-3376
✔ PECOS✔ Accepts Medicare95 mi
Chelsey Straight, MD
Micrographic Dermatologic Surgery (MDS)
NPI 1699161174
8701 W HIGHWAY 71 STE 101
Austin, TX 78735
(512) 766-2610
✔ PECOS✔ Accepts Medicare96 mi
See all 103 clinicians

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 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, 2028
CLIA Number45D2311168
Laboratory TypePhysician Office
Certificate Effective DateSeptember 17, 2026
Certificate Expiration DateSeptember 16, 2028
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.

Is Epiphany Dermatology PA enrolled in Medicare?

Yes. Epiphany Dermatology PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Epiphany Dermatology PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 103 clinicians in 6 Medicare specialties reassign their Medicare billing to Epiphany Dermatology PA. 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. The largest specialties are Dermatology (87), Nurse Practitioner (11) and Pathology (2). Of these, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 5 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.