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LADERA PARK DERMATOLOGY PA
NPI 1225567704
Dermatology in Austin, TX

Active since June 08, 2017CLIA 45D0962094 · Microscopy
11671 JOLLYVILLE RD STE 104, AUSTIN, TX 78759(512) 345-3599(512) 345-3928 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 21, 2022, Oct 26, 2017, Aug 10, 2017 and 1 more (4 updates tracked since 2017).

About Ladera Park Dermatology Pa NPPES

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

LADERA PARK DERMATOLOGY PA (NPI 1225567704), doing business as Lake Travis Dermatology Pa, is a healthcare organization registered as a dermatology in Austin, Texas and active in the NPI registry since June 2017. The organization holds a CLIA Microscopy certificate valid through June 22, 2027 and lists Adrienne M Feasel, President, as its authorized official.

NPPES Registry Identity

NPI1225567704
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameLADERA PARK DERMATOLOGY PA
Location Address11671 JOLLYVILLE RD STE 104Austin, TX 78759-4141
Mailing Address11671 Jollyville Rd Ste 104Austin, TX 78759-4141 · (512) 345-3599 · Fax (512) 345-3928
Phone(512) 345-3599
Fax(512) 345-3928
Organization SubpartNo
Authorized OfficialAdrienne M FeaselPresident · (512) 345-3599
Enumeration DateJune 8, 2017
Last NPPES UpdateJuly 21, 20224 updates tracked since enumeration
✔ NPI 1225567704 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in TX · L2883
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.
11671 JOLLYVILLE RD STE 104, Austin, TX 78759
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Other Names 1

Former Legal Business NameLake Travis Dermatology Pa

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 WellPoint.Insurance ›

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) 45D0962094

Ladera Park Dermatology, PA · Austin, TX
Active · expires Jun 22, 2027
CLIA Number45D0962094
Laboratory TypePhysician Office
Certificate Effective DateJune 23, 2025
Certificate Expiration DateJune 22, 2027
Laboratory DirectorAdrienne M. Feasel, MD
Laboratory Phone(512) 345-3599
Laboratory LocationLadera Park Dermatology, PA11671 Jollyville Road, Suite 104, Austin, TX 78759
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.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LADERA PARK DERMATOLOGY, P.A.
Dermatology
11671 JOLLYVILLE RD STE 104
AUSTIN, TX 78759
Travis County (512) 345-3599

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 Ladera Park Dermatology PA's NPI number?

The NPI number for Ladera Park Dermatology PA is 1225567704. It was assigned to this organization in the NPPES registry on June 8, 2017. The provider was formerly known as Lake Travis Dermatology PA.

Where is Ladera Park Dermatology PA located?

Ladera Park Dermatology PA is located at 11671 Jollyville Rd Ste 104, Austin, TX 78759. The listed phone number is (512) 345-3599.

What is Ladera Park Dermatology PA's specialty?

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

Does Ladera Park Dermatology PA hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D0962094) is associated with this NPI, valid through June 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Ladera Park Dermatology PA accept?

Health plans from WellPoint list Ladera Park Dermatology PA 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 Ladera Park Dermatology PA was last updated on July 21, 2022. 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.