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EPIPHANY DERMATOLOGY OF IOWA, PLC
NPI 1104451749
Dermatology in Cedar Rapids, IA

Active since March 04, 2020CLIA 16D0386795 · Certificate of Compliance
5264 COUNCIL ST NE STE 700, CEDAR RAPIDS, IA 52402(319) 363-9963(319) 363-0520 Get Directions Write a Review

NPPES record last updated: December 7, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 7, 2023, Mar 4, 2020 (2 updates tracked since 2020).

About Epiphany Dermatology Of Iowa, Plc NPPES

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

EPIPHANY DERMATOLOGY OF IOWA, PLC (NPI 1104451749) is a healthcare organization registered as a dermatology in Cedar Rapids, Iowa and active in the NPI registry since March 2020. The organization holds a CLIA Certificate of Compliance certificate valid through January 5, 2028 and lists Gheorghe Pusta, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1104451749
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameEPIPHANY DERMATOLOGY OF IOWA, PLC
Location Address5264 COUNCIL ST NE STE 700Cedar Rapids, IA 52402-2477
Mailing Address7300 Ranch Rd. 2222, Bldg 1, Ste 200Austin, TX 78730-3255 · (512) 628-0465
Phone(319) 363-9963
Fax(319) 363-0520
Organization SubpartNo
Authorized OfficialGheorghe PustaExecutive Director · (512) 628-0465
Enumeration DateMarch 4, 2020
Last NPPES UpdateDecember 7, 20232 updates tracked since enumeration
NPPES CertifiedDecember 7, 2023
✔ NPI 1104451749 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
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.
5264 COUNCIL ST NE STE 700, Cedar Rapids, IA 52402
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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)

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

Clinicians Billing Medicare Through This Organization

15

Medicare enrollment records show 15 clinicians reassign Medicare billing to Epiphany Dermatology Of Iowa, Plc, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians by Medicare Specialty 2

Dermatology12
Nurse Practitioner3

Clinicians, nearest first (15)

John Wollner, M.D.
Dermatology
NPI 1568423192
5264 COUNCIL ST NE STE 700
Cedar Rapids, IA 52402
(319) 363-9936
✔ PECOS✔ Accepts MedicareSame address
Alexandra Collins, FNP-C
Nurse Practitioner
NPI 1841068855
1100 6TH ST STE 202
Coralville, IA 52241
(319) 337-4566
✔ PECOS✔ Accepts Medicare25 mi
Hobart Walling, M.D.
Dermatology
NPI 1477506814
1100 6TH ST SUITE 202
Coralville, IA 52241
(319) 337-4566
✔ PECOS✔ Accepts Medicare25 mi
Kristi Robson, MD
Dermatology
NPI 1730128653
1100 6TH ST SUITE 202
Coralville, IA 52241
(319) 337-4566
✔ PECOS✔ Accepts Medicare25 mi
David Boysen, M.D.
Dermatology
NPI 1972687911
501 12TH AVE SUITE 101
Coralville, IA 52241
(319) 337-3177
✔ PECOS✔ Accepts Medicare25 mi
Thomas Boysen, M.D.
Dermatology
NPI 1851475750
501 12TH AVE SUITE 101
Coralville, IA 52241
(319) 337-3177
✔ PECOS✔ Accepts Medicare25 mi
Hannah Thompson, MD
Dermatology
NPI 1861060220
501 12TH AVE STE 101
Coralville, IA 52241
(319) 337-3177
✔ PECOS✔ Accepts Medicare25 mi
Logan Skelley, M.D.
Dermatology
NPI 1851710727
1100 5TH ST STE 270
Coralville, IA 52241
(512) 628-0465
✔ PECOS✔ Accepts Medicare25 mi
Heather Ciliberto, MD
Dermatology
NPI 1447408869
200 HAWKINS DR DEPT OF DERMATOLOGY
Iowa City, IA 52242
(319) 356-7546
✔ PECOS✔ Accepts Medicare26 mi
Laura Correa Ferrer, MD
Dermatology
NPI 1033605100
200 HAWKINS DR
Iowa City, IA 52242
(319) 356-1694
✔ PECOS26 mi
Jennifer Palmer, M.D.
Dermatology
NPI 1801893862
WESTPOORT MEDICAL PLAZA 2605 WASHINGTON STREET
Pella, IA 50219
(641) 620-9119
✔ PECOS✔ Accepts Medicare79 mi
Tonia Ackerman, ARNP
Nurse Practitioner
NPI 1932142692
5900 E UNIVERSITY AVE STE 301
Pleasant Hill, IA 50327
(515) 304-3880
✔ PECOS✔ Accepts Medicare99 mi
Megan Ferguson, ARNP
Nurse Practitioner
NPI 1558698753
5900 E UNIVERSITY AVE STE 301
Pleasant Hill, IA 50327
(515) 304-3880
✔ PECOS✔ Accepts Medicare99 mi
Jennifer Herrmann, M.D.
Dermatology
NPI 1245521756
200 COOL SPRINGS BLVD
Franklin, TN 37067
(615) 771-8600
✔ PECOS✔ Accepts Medicare494 mi
Nicole Annest, M.D.
Dermatology
NPI 1205842051
280 EXEMPLA CIR
Lafayette, CO 80026
(303) 338-4545
✔ PECOS✔ Accepts Medicare715 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 16D0386795

Epiphany Dermatology Of Iowa, Plc · Cedar Rapids, IA
Active · expires Jan 5, 2028
CLIA Number16D0386795
Laboratory TypePhysician Office
Certificate Effective DateJanuary 6, 2026
Certificate Expiration DateJanuary 5, 2028
Laboratory DirectorJohn H. Wollner
Laboratory Phone(319) 363-9936
Laboratory LocationEpiphany Dermatology Of Iowa, Plc5264 Council St NE Ste 700, Cedar Rapids, IA 52402
CLIA data matches this NPI record on: Address 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 Epiphany Dermatology Of Iowa, Plc's NPI number?

The NPI number for Epiphany Dermatology Of Iowa, Plc is 1104451749. It was assigned to this organization in the NPPES registry on March 4, 2020.

Where is Epiphany Dermatology Of Iowa, Plc located?

Epiphany Dermatology Of Iowa, Plc is located at 5264 Council St NE Ste 700, Cedar Rapids, IA 52402. The listed phone number is (319) 363-9963.

What is Epiphany Dermatology Of Iowa, Plc's specialty?

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

Is Epiphany Dermatology Of Iowa, Plc enrolled in Medicare?

Yes. Epiphany Dermatology Of Iowa, Plc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Epiphany Dermatology Of Iowa, Plc?

According to the CMS Revalidation Reassignment List (October 2026 release), 15 clinicians in 2 Medicare specialties reassign their Medicare billing to Epiphany Dermatology Of Iowa, Plc. 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 (12) and Nurse Practitioner (3). Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Epiphany Dermatology Of Iowa, Plc hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 16D0386795) is associated with this NPI, valid through January 5, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Epiphany Dermatology Of Iowa, Plc was last updated on December 7, 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.