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LONE STAR STATE DERMATOLOGY CLINIC PLLC
NPI 1053723239
Dermatology - Procedural Dermatology in Live Oak, TX

Active since May 22, 2014
11101 TOEPPERWEIN RD, LIVE OAK, TX 78233(210) 651-3233(210) 651-3234 Get Directions Write a Review

NPPES record last updated: December 20, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Lone Star State Dermatology Clinic Pllc NPPES

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

LONE STAR STATE DERMATOLOGY CLINIC PLLC (NPI 1053723239) is a healthcare organization registered as a procedural dermatology in Live Oak, Texas and active in the NPI registry since May 2014. The organization lists Myra Peacock, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1053723239
Entity TypeOrganization
Primary Taxonomy207NS0135X
Legal Business NameLONE STAR STATE DERMATOLOGY CLINIC PLLC
Location Address11101 TOEPPERWEIN RDLive Oak, TX 78233-3048
Mailing Address11101 Toepperwein RdLive Oak, TX 78233-3048 · (210) 651-3233 · Fax (210) 651-3234
Phone(210) 651-3233
Fax(210) 651-3234
Organization SubpartNo
Authorized OfficialMyra PeacockOffice Manager · (210) 651-3233
Enumeration DateMay 22, 2014
Last NPPES UpdateDecember 20, 2023
NPPES CertifiedDecember 20, 2023
✔ NPI 1053723239 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · Procedural DermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207NS0135X
License✔ Licensed in TX · K8022
Definition
Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).
11101 TOEPPERWEIN RD, Live Oak, TX 78233
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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 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)

Lone Star State Dermatology Clinic Pllc 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 Lone Star State Dermatology Clinic PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Jean-Denis Boucher, M.D.
Dermatology
NPI 1205827532
11101 TOEPPERWEIN RD
Live Oak, TX 78233
(210) 651-3233
✔ PECOS✔ Accepts MedicareSame address
Derek Deleon, APRN
Nurse Practitioner
NPI 1609514785
4502 MEDICAL DR
San Antonio, TX 78229
(210) 358-4000
✔ PECOS✔ Accepts Medicare15 mi

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 Lone Star State Dermatology Clinic PLLC's NPI number?

The NPI number for Lone Star State Dermatology Clinic PLLC is 1053723239. It was assigned to this organization in the NPPES registry on May 22, 2014.

Where is Lone Star State Dermatology Clinic PLLC located?

Lone Star State Dermatology Clinic PLLC is located at 11101 Toepperwein Rd, Live Oak, TX 78233. The listed phone number is (210) 651-3233.

What is Lone Star State Dermatology Clinic PLLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.

Is Lone Star State Dermatology Clinic PLLC enrolled in Medicare?

Yes. Lone Star State Dermatology Clinic PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lone Star State Dermatology Clinic PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Lone Star State Dermatology Clinic PLLC, 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, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Lone Star State Dermatology Clinic PLLC was last updated on December 20, 2023. 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.