EPIPHANY DERMATOLOGY OF OREGON, LLC
NPI 1174697239
Dermatology in Portland, OR

NPI Status: Active since November 20, 2006

Contact Information

2222 NW LOVEJOY ST
SUITE 422
PORTLAND, OR
ZIP 97210
Phone: (503) 227-7117
Fax: (503) 227-7120

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  • Organization
  • Dermatology
  • Accepts Insurance
  • CLIA Number: 38D0954415
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 09-08-2026

About EPIPHANY DERMATOLOGY OF OREGON, LLC

This page provides the complete NPI Profile along with additional information for Epiphany Dermatology Of Oregon, Llc, a provider established in Portland, Oregon operating as a Dermatology. The healthcare provider is registered in the NPI registry with number 1174697239 assigned on November 2006. The practitioner's primary taxonomy code is 207N00000X. The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Gheorghe Pusta (Secretary)

NPI
1174697239
Provider Name
EPIPHANY DERMATOLOGY OF OREGON, LLC
Entity Type
Organization
Location Address
2222 NW LOVEJOY ST SUITE 422 PORTLAND, OR 97210
Location Phone
(503) 227-7117
Location Fax
(503) 227-7120
Mailing Address
7300 RANCH ROAD 2222, BLDG 1, STE 200 AUSTIN, TX 78730
Mailing Phone
(512) 628-0465
Mailing Fax
(503) 227-7120
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
11-20-2006
Last Update Date
07-21-2025
Code Navigator

A dermatologist like Epiphany Dermatology Of Oregon, Llc is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Dermatology

Taxonomy Code
207N00000X
Type
Allopathic & Osteopathic Physicians
Taxonomy Description
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.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • BridgeSpan Standard Bronze Plan - EPO
  • BridgeSpan Standard Gold Plan - EPO
  • BridgeSpan Standard Silver Plan - EPO
  • Moda Health Affinity Bronze 8000 - EPO
  • Moda Health Affinity Bronze 9000 - EPO
  • Moda Health Affinity Bronze HDHP 7500 - EPO
  • Moda Health Affinity Gold 1000 - EPO
  • Moda Health Affinity Gold 1500 - EPO
  • Moda Health Affinity Gold 250 - EPO
  • Moda Health Affinity Silver 3000 - EPO
  • Moda Health Affinity Silver 3400 - EPO
  • Moda Health Affinity Silver 4500 - EPO
  • Moda Health Affinity Silver 6000 - EPO
  • Moda Health Oregon Standard Bronze Affinity - EPO
  • Moda Health Oregon Standard Gold Affinity - EPO
  • Moda Health Oregon Standard Silver Affinity - EPO
  • Bronze 8000 Individual Connect - EPO
  • Bronze Essential 9000 With 4 Copay No Deductible Office Visits Individual Connect - EPO
  • Bronze Essential 9000 With 4 Copay No Deductible Office Visits Legacy - EPO
  • Bronze HSA 7000 Individual Connect - EPO
  • Gold 2300 Individual Connect - EPO
  • Gold 2300 Legacy - EPO
  • Regence Standard Bronze Plan Individual Connect - EPO
  • Regence Standard Bronze Plan Legacy - EPO
  • Regence Standard Gold Plan Individual Connect - EPO
  • Regence Standard Gold Plan Legacy - EPO
  • Regence Standard Silver Plan Individual Connect - EPO
  • Regence Standard Silver Plan Legacy - EPO
  • Silver 6500 Individual Connect - EPO
  • Silver 6500 Legacy - EPO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

GHEORGHE PUSTA

Authorized Official Title
SECRETARY
Authorized Official Phone
(512) 628-0465

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
38D0954415
Facility Type
Physician Office
Certificate Effective Date
September 09, 2024
Certificate Expiration Date
September 08, 2026
Laboratory Director
PATRICIA L. NORRIS
Certificate Type
Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description
This CLIA certificate is issued to Epiphany Dermatology Of Oregon, Llc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1174697239, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
1
Unchanged
Pos 3
7
Doubled → 14 → 1 + 4
Pos 4
4
Unchanged
Pos 5
6
Doubled → 12 → 1 + 2
Pos 6
9
Unchanged
Pos 7
7
Doubled → 14 → 1 + 4
Pos 8
2
Unchanged
Pos 9
3
Doubled → 6
Check
9
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 7 → 14 → 5 6 → 12 → 3 7 → 14 → 5 3 → 6

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 1 + 1 + 4 + 4 + 1 + 2 + 9 + 1 + 4 + 2 + 6 + 24 = 61

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 61 is 70. The difference is the calculated check digit.

70 - 61 = 9
This NPI is valid
The calculated check digit is 9, which matches the last digit of 1174697239.

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

Nurse Practitioner
2222 NW LOVEJOY ST, SUITE 606
PORTLAND, OR 97210
Nurse Practitioner
2222 NW LOVEJOY ST, SUITE 606
PORTLAND, OR 97210
Physician Assistant (Surgical)
2222 NW LOVEJOY ST, SUITE 315
PORTLAND, OR 97210
Thoracic Surgery (Cardiothoracic Vascular Surgery)
2222 NW LOVEJOY ST, SUITE 315
PORTLAND, OR 97210
Thoracic Surgery (Cardiothoracic Vascular Surgery)
2222 NW LOVEJOY ST, SUITE 315
PORTLAND, OR 97210
Internal Medicine
2222 NW LOVEJOY ST, #422
PORTLAND, OR 97210
Internal Medicine (Pulmonary Disease)
2222 NW LOVEJOY ST, SUITE 411
PORTLAND, OR 97210
Ophthalmology
2222 NW LOVEJOY ST, SUITE 504
PORTLAND, OR 97210
Internal Medicine (Pulmonary Disease)
2222 NW LOVEJOY ST, SUITE 411, MOB 1
PORTLAND, OR 97210
Internal Medicine
2222 NW LOVEJOY ST, 408
PORTLAND, OR 97210
Surgery
2222 NW LOVEJOY ST, SUITE 322
PORTLAND, OR 97210
Specialist
2222 NW LOVEJOY ST, #607
PORTLAND, OR 97210
Specialist
2222 NW LOVEJOY ST, #607
PORTLAND, OR 97210
Internal Medicine (Cardiovascular Disease)
2222 NW LOVEJOY ST, SUITE 512
PORTLAND, OR 97210
Nurse Practitioner (Family)
2222 NW LOVEJOY ST, SUITE 411, MOB 1
PORTLAND, OR 97210
Podiatrist
2222 NW LOVEJOY ST, #510
PORTLAND, OR 97210
Ophthalmology
2222 NW LOVEJOY ST, SUITE 504
PORTLAND, OR 97210
Dermatology
2222 NW LOVEJOY ST, SUITE 422
PORTLAND, OR 97210
Urology
2222 NW LOVEJOY ST, SUITE 416
PORTLAND, OR 97210
Eyewear Supplier
2222 NW LOVEJOY ST, SUITE 500
PORTLAND, OR 97210

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1174697239, enumerated as an "organization" on November 20, 2006.

The provider is located at 2222 NW LOVEJOY ST SUITE 422 PORTLAND, OR 97210 and the phone number is (503) 227-7117.

Dermatology with taxonomy code 207N00000X.

The provider might be accepting Accepts: BridgeSpan Health Company, Moda Health Plan, Inc.. Please consult your insurance carrier or call the provider to verify.