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SOUTH TEXAS DERMATOLOGY
NPI 1356536494
Dermatology - MOHS-Micrographic Surgery in Corpus Christi, TX

Active since September 12, 2007
4141 S. STAPLES SUITE 300, CORPUS CHRISTI, TX 78411(361) 882-5560(361) 882-6011 Get Directions Write a Review

NPPES record last updated: July 14, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 14, 2022, May 16, 2017 (2 updates tracked since 2017).

About South Texas Dermatology NPPES

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

SOUTH TEXAS DERMATOLOGY (NPI 1356536494) is a healthcare organization registered as a mohs-micrographic surgery in Corpus Christi, Texas and active in the NPI registry since September 2007. The organization maintains 5 additional practice locations and lists Jennifer Lynn Vincent, Prqactice Manager, as its authorized official.

NPPES Registry Identity

NPI1356536494
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameSOUTH TEXAS DERMATOLOGY PLLC
Location Address4141 S. STAPLES SUITE 300Corpus Christi, TX 78411-2929
Mailing Address4141 S. Staples Suite 300Corpus Christi, TX 78411-2929 · (361) 882-5560 · Fax (361) 882-6011
Phone(361) 882-5560
Fax(361) 882-6011
Organization SubpartNo
Authorized OfficialJennifer Lynn VincentPrqactice Manager · (361) 882-5560
Enumeration DateSeptember 12, 2007
Last NPPES UpdateJuly 14, 20222 updates tracked since enumeration
NPPES CertifiedJuly 14, 2022
✔ NPI 1356536494 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
License✔ Licensed in TX · J4105
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
4141 S. STAPLES SUITE 300, Corpus Christi, TX 78411
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Other Names 1

Doing Business AsSouth Texas Dermatology

Secondary Practice Locations 5

Location 15920 Saratoga Blvd Ste 470Corpus Christi, TX 78414-4108 · Phone (361) 882-5560 · Fax (361) 882-6011
Location 213725 Northwest Blvd Ste 11Corpus Christi, TX 78410-5124 · Phone (361) 882-5560 · Fax (361) 882-6011
Location 3400 Enterprise Blvd Bldg D4Rockport, TX 78382-4341 · Phone (361) 882-5560 · Fax (361) 882-6011
Location 41311 E General Cavazos Blvd Ste FKingsville, TX 78363-7129 · Phone (361) 882-5560 · Fax (361) 882-6011
Location 51711 W Wheeler Ave Ste 3Aransas Pass, TX 78336-4536 · Phone (361) 882-5560 · Fax (361) 882-6011

Other Identifiers 4

Other0040EETX · Blue Cross Blue Shield
MedicaidTXB158324TX
Medicaid080856001TX
OtherCK7292TX · Medicare Railroad

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)

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

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to South Texas Dermatology, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (6)

Nathan Davis, MD
Dermatology
NPI 1841443231
4141 S. STAPLES SUITE 300
Corpus Christi, TX 78411
(361) 882-5560
✔ PECOS✔ Accepts MedicareSame address
Wayne Fagan, M.D.
Dermatology
NPI 1942206180
4141 S. STAPLES SUITE 300
Corpus Christi, TX 78411
(361) 882-5560
✔ PECOS✔ Accepts MedicareSame address
Ellen Mitchell, RN, BC, FNP,ANP,MSN
Nurse Practitioner
NPI 1194742726
2500 E MAIN ST
Alice, TX 78332
(361) 661-8000
✔ PECOS41 mi
Ben Treen, M.D.
Dermatology
NPI 1457466971
2121 SW 22ND PL
Ocala, FL 34471
(352) 237-4133
✔ PECOS✔ Accepts Medicare931 mi
David Cowart, M.D.
Dermatology
NPI 1578901047
5089 WEST 11800 SOUTH SUITE 202
Herriman, UT 84096
(801) 980-2546
✔ PECOS1,214 mi
Emily Wong, M.D.
Dermatology
NPI 1518057009
99-128 AIEA HEIGHTS DR STE 701
Aiea, HI 96701
(808) 888-3311
✔ PECOS✔ Accepts Medicare3,800 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 South Texas Dermatology PLLC's NPI number?

The NPI number for South Texas Dermatology PLLC is 1356536494. It was assigned to this organization in the NPPES registry on September 12, 2007. The provider is doing business as South Texas Dermatology.

Where is South Texas Dermatology PLLC located?

South Texas Dermatology PLLC is located at 4141 S. Staples Suite 300, Corpus Christi, TX 78411. The listed phone number is (361) 882-5560.

What is South Texas Dermatology PLLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is South Texas Dermatology PLLC enrolled in Medicare?

Yes. South Texas Dermatology PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through South Texas Dermatology PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to South Texas Dermatology PLLC. 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. The largest specialties are Dermatology (5) and Nurse Practitioner (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for South Texas Dermatology PLLC was last updated on July 14, 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.