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TETON DERMATOLOGY, INC
NPI 1194044750
Dermatology in Jackson, WY

Active since May 21, 2010CLIA Certified · 4 labs
984 WEST BROADWAY, SUITE 4, JACKSON, WY 83001(307) 734-1800(307) 734-5012 Get Directions Write a Review

NPPES record last updated: December 17, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 18, 2024, Dec 7, 2023, Dec 17, 2021 and 2 more (5 updates tracked since 2021).

About Teton Dermatology, Inc NPPES

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

TETON DERMATOLOGY, INC (NPI 1194044750) is a healthcare organization registered as a dermatology in Jackson, Wyoming and active in the NPI registry since May 2010. The organization holds 4 active CLIA laboratory certificates and lists Gheorghe Pusta, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1194044750
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameTETON DERMATOLOGY, INC
Location Address984 WEST BROADWAY, SUITE 4Jackson, WY 83001-0000
Mailing AddressP.o. Box 14510Jackson, WY 83002-4510 · (307) 734-1800 · Fax (307) 734-5012
Phone(307) 734-1800
Fax(307) 734-5012
Organization SubpartNo
Authorized OfficialGheorghe PustaExecutive Director · (512) 628-0465
Enumeration DateMay 21, 2010
Last NPPES UpdateDecember 17, 20215 updates tracked since enumeration
NPPES CertifiedDecember 17, 2021
✔ NPI 1194044750 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.
984 WEST BROADWAY, Jackson, WY 83001
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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Wyoming.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)

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

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Teton Dermatology, Inc, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Jonathan Baker, M.D.
Dermatology
NPI 1447233754
984 WEST BROADWAY SUITE 4
Jackson, WY 83001
(307) 734-1800
✔ PECOS✔ Accepts MedicareSame address
Brittany Baker, MD
Dermatology
NPI 1265653745
984 W BROADWAY SUITE 4
Jackson, WY 83001
(307) 734-1800
✔ PECOS✔ Accepts MedicareSame address
Jane Khoury, M.D.
Dermatology
NPI 1245246214
600 CORPORATE DR SUITE 240
Ladera Ranch, CA 92694
(949) 364-8411
✔ PECOS✔ Accepts Medicare777 mi
Nathan Uebelhoer, D.O.
Dermatology
NPI 1659344513
655 EUCLID AVE STE 304
National City, CA 91950
(619) 267-8303
✔ PECOS✔ Accepts Medicare819 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 4

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 53D2009726

Teton Dermatology, LLC Dba Epiphany Dermatology · Jackson, WY
Active · expires Feb 27, 2027
CLIA Number53D2009726
Laboratory TypePhysician Office
Certificate Effective DateFebruary 28, 2025
Certificate Expiration DateFebruary 27, 2027
Laboratory DirectorJonathan Baker
Laboratory Phone(307) 734-1800
Laboratory LocationTeton Dermatology, LLC Dba Epiphany Dermatology984 W Broadway, Ste 4, Jackson, WY 83001
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 53D2311528

Teton Dermatology, LLC Dba Epiphany Dermatology · Pinedale, WY
Active · expires Sep 23, 2028
CLIA Number53D2311528
Laboratory TypePhysician Office
Certificate Effective DateSeptember 24, 2026
Certificate Expiration DateSeptember 23, 2028
Laboratory DirectorRobin C. Sproule
Laboratory Phone(307) 734-1800
Laboratory LocationTeton Dermatology, LLC Dba Epiphany Dermatology625 Hennick Street, Pinedale, WY 82941
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 53D2311531

Teton Dermatology, LLC Dba Epiphany Dermatology · Afton, WY
Active · expires Sep 23, 2028
CLIA Number53D2311531
Laboratory TypePhysician Office
Certificate Effective DateSeptember 24, 2026
Certificate Expiration DateSeptember 23, 2028
Laboratory DirectorRobin C. Sproule
Laboratory Phone(307) 734-1800
Laboratory LocationTeton Dermatology, LLC Dba Epiphany Dermatology901 Adams Street, Afton, WY 83110
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 53D2311542

Teton Dermatology, LLC Dba Epiphany Dermatology · Dubois, WY
Active · expires Sep 23, 2028
CLIA Number53D2311542
Laboratory TypePhysician Office
Certificate Effective DateSeptember 24, 2026
Certificate Expiration DateSeptember 23, 2028
Laboratory DirectorRobin C. Sproule
Laboratory Phone(307) 734-1800
Laboratory LocationTeton Dermatology, LLC Dba Epiphany Dermatology5647 Us Hwy 26, Dubois, WY 82513
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 Teton Dermatology, Inc's NPI number?

The NPI number for Teton Dermatology, Inc is 1194044750. It was assigned to this organization in the NPPES registry on May 21, 2010.

Where is Teton Dermatology, Inc located?

Teton Dermatology, Inc is located at 984 West Broadway Suite 4, Jackson, WY 83001. The listed phone number is (307) 734-1800.

What is Teton Dermatology, Inc's specialty?

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

Is Teton Dermatology, Inc enrolled in Medicare?

Yes. Teton Dermatology, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Teton Dermatology, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Dermatology, reassign their Medicare billing to Teton Dermatology, Inc. 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Teton Dermatology, Inc hold CLIA laboratory certificates?

Yes. 4 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 Teton Dermatology, Inc accept?

Health plans from Blue Cross Blue Shield of Wyoming list Teton Dermatology, Inc 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 Teton Dermatology, Inc was last updated on December 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.