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CONCIERGE DERMATOLOGY MANAGEMENT, LLC
NPI 1134615206
Dermatology in Fort Worth, TX

Active since July 02, 2018CLIA Certified · 2 labs
7100 OAKMONT BLVD STE 101, FORT WORTH, TX 76132(817) 205-3075(817) 641-3355 Get Directions Write a Review

NPPES record last updated: October 24, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Concierge Dermatology Management, Llc NPPES

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

CONCIERGE DERMATOLOGY MANAGEMENT, LLC (NPI 1134615206) is a healthcare organization registered as a dermatology in Fort Worth, Texas and active in the NPI registry since July 2018. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Cleburne, and lists Brittany Pope, Manager, as its authorized official.

NPPES Registry Identity

NPI1134615206
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameCONCIERGE DERMATOLOGY MANAGEMENT, LLC
Location Address7100 OAKMONT BLVD STE 101Fort Worth, TX 76132-3908
Mailing Address7100 Oakmont Blvd Ste 101Fort Worth, TX 76132-3908 · (817) 205-3075
Phone(817) 205-3075
Fax(817) 641-3355
Organization SubpartNo
Authorized OfficialBrittany PopeManager · (817) 781-3550
Enumeration DateJuly 2, 2018
Last NPPES UpdateOctober 24, 2025
NPPES CertifiedOctober 24, 2025
✔ NPI 1134615206 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 · K0518
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 ListedRegistered Nurse · Wound CareTaxonomy 163WW0000X
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X · License K0518 (TX)
7100 OAKMONT BLVD STE 101, Fort Worth, TX 76132
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Secondary Practice Location 1

Location 1405 N Ridgeway Dr Ste GCleburne, TX 76033-5130 · Phone (817) 205-3075

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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)

Concierge Dermatology Management, Llc 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 Concierge Dermatology Management, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Peter Malouf, D.O.
Dermatology
NPI 1225047012
7100 OAKMONT BLVD STE 101
Fort Worth, TX 76132
(817) 205-3075
✔ PECOS✔ Accepts MedicareSame address
Jean Elizze Charles, D.O.
Dermatology
NPI 1376075507
4235 WILLIAMS DR
Georgetown, TX 78628
(512) 279-3376
✔ PECOS✔ Accepts Medicare138 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 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 45D2261384

Concierge Dermatology · Fort Worth, TX
Active · expires May 14, 2028
CLIA Number45D2261384
Laboratory TypePhysician Office
Certificate Effective DateMay 15, 2026
Certificate Expiration DateMay 14, 2028
Laboratory DirectorPeter J. Malouf
Laboratory Phone(817) 205-3075
Laboratory LocationConcierge Dermatology7100 Oakmont Blvd Suite 101, Fort Worth, TX 76132
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 Compliance 45D2156583

Concierge Dermatology · Cleburne, TX
Active · expires Nov 26, 2027
CLIA Number45D2156583
Laboratory TypePhysician Office
Certificate Effective DateNovember 27, 2025
Certificate Expiration DateNovember 26, 2027
Laboratory DirectorPeter J. Malouf
Laboratory Phone(817) 205-3075
Laboratory LocationConcierge Dermatology405 N Ridgeway Drive Suite G, Cleburne, TX 76033
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.

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 Concierge Dermatology Management, LLC's NPI number?

The NPI number for Concierge Dermatology Management, LLC is 1134615206. It was assigned to this organization in the NPPES registry on July 2, 2018.

Where is Concierge Dermatology Management, LLC located?

Concierge Dermatology Management, LLC is located at 7100 Oakmont Blvd Ste 101, Fort Worth, TX 76132. The listed phone number is (817) 205-3075.

What is Concierge Dermatology Management, LLC's specialty?

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

Is Concierge Dermatology Management, LLC enrolled in Medicare?

Yes. Concierge Dermatology Management, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Concierge Dermatology Management, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Concierge Dermatology Management, LLC. 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.

Does Concierge Dermatology Management, LLC 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.

When was this NPI record last updated?

The NPPES record for Concierge Dermatology Management, LLC was last updated on October 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.