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BAYSIDE DERMATOLOGY PA
NPI 1215160312
Dermatology in Granbury, TX

Active since August 24, 2009CLIA 45D1105005 · Microscopy
1321 WATERS EDGE DR STE 1006, GRANBURY, TX 76048(817) 573-1800(817) 573-8601 Get Directions Write a Review

NPPES record last updated: June 4, 2026. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Bayside Dermatology Pa NPPES

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

BAYSIDE DERMATOLOGY PA (NPI 1215160312) is a healthcare organization registered as a dermatology in Granbury, Texas and active in the NPI registry since August 2009. The organization holds a CLIA Microscopy certificate valid through September 14, 2027 and lists Donald Jeffrey Brown, Owner/principal, as its authorized official.

NPPES Registry Identity

NPI1215160312
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameBAYSIDE DERMATOLOGY PA
Location Address1321 WATERS EDGE DR STE 1006Granbury, TX 76048-1234
Mailing Address1321 Waters Edge Dr Ste 1006Granbury, TX 76048-1234 · (817) 573-1800 · Fax (817) 573-8601
Phone(817) 573-1800
Fax(817) 573-8601
Organization SubpartNo
Authorized OfficialDonald Jeffrey BrownOwner/principal · (817) 573-1800
Enumeration DateAugust 24, 2009
Last NPPES UpdateJune 4, 2026
NPPES CertifiedJune 4, 2026
✔ NPI 1215160312 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.
1321 WATERS EDGE DR STE 1006, Granbury, TX 76048
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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)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Bayside Dermatology PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Donald Brown, DO
Dermatology
NPI 1861555237
1321 WATERS EDGE DR STE 1006
Granbury, TX 76048
(817) 573-1800
✔ PECOS✔ Accepts MedicareSame address

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 for Provider-Performed Microscopy Procedures (PPMP) 45D1105005

Bayside Dermatology, PA · Granbury, TX
Active · expires Sep 14, 2027
CLIA Number45D1105005
Laboratory TypePhysician Office
Certificate Effective DateSeptember 15, 2025
Certificate Expiration DateSeptember 14, 2027
Laboratory DirectorDonald J. Brown, Do
Laboratory Phone(817) 573-1800
Laboratory LocationBayside Dermatology, PA1321 Waters Edge Drive, Suite 1006, Granbury, TX 76048
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform 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 Bayside Dermatology PA's NPI number?

The NPI number for Bayside Dermatology PA is 1215160312. It was assigned to this organization in the NPPES registry on August 24, 2009.

Where is Bayside Dermatology PA located?

Bayside Dermatology PA is located at 1321 Waters Edge Dr Ste 1006, Granbury, TX 76048. The listed phone number is (817) 573-1800.

What is Bayside Dermatology PA's specialty?

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

Is Bayside Dermatology PA enrolled in Medicare?

Yes. Bayside Dermatology PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Bayside Dermatology PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Bayside Dermatology PA. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Bayside Dermatology PA hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D1105005) is associated with this NPI, valid through September 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bayside Dermatology PA was last updated on June 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.