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EPIPHANY DERMATOLOGY OF ARIZONA, LLC
NPI 1457465858
Dermatology in Peoria, AZ

Active since August 19, 2006CLIA Certified · 3 labs
7767 W DEER VALLEY RD, SUITE 140, PEORIA, AZ 85382(623) 487-3003(623) 487-0952 Get Directions Write a Review

NPPES record last updated: December 7, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 7, 2023, Dec 13, 2018 (2 updates tracked since 2018).

About Epiphany Dermatology Of Arizona, Llc NPPES

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

EPIPHANY DERMATOLOGY OF ARIZONA, LLC (NPI 1457465858) is a healthcare organization registered as a dermatology in Peoria, Arizona and active in the NPI registry since August 2006. The organization holds 3 active CLIA laboratory certificates and lists Gheorghe Pusta, Ceo, as its authorized official.

NPPES Registry Identity

NPI1457465858
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameEPIPHANY DERMATOLOGY OF ARIZONA, LLC
Location Address7767 W DEER VALLEY RD, SUITE 140Peoria, AZ 85382-2103
Mailing Address7300 Ranch Rd. 2222, Bldg 1, Ste 200Austin, TX 78730 · (512) 628-0465 · Fax (512) 628-0468
Phone(623) 487-3003
Fax(623) 487-0952
Organization SubpartNo
Authorized OfficialGheorghe PustaCeo · (512) 628-0465
Enumeration DateAugust 19, 2006
Last NPPES UpdateDecember 7, 20232 updates tracked since enumeration
NPPES CertifiedDecember 7, 2023
✔ NPI 1457465858 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.
7767 W DEER VALLEY RD, Peoria, AZ 85382
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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 Ambetter from Arizona Complete Health, Ambetter Health, Imperial Insurance Companies, Inc..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)

Epiphany Dermatology Of Arizona, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

31

Medicare enrollment records show 31 clinicians reassign Medicare billing to Epiphany Dermatology Of Arizona, LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 5 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 2

Dermatology29
Nurse Practitioner2

Nearest to this location (20)

See all 31
Keith Haar, MD
Dermatology
NPI 1902852320
7767 W. DEER VALLEY RD
Peoria, AZ 85382
(623) 487-3003
✔ PECOS✔ Accepts MedicareSame address
Dane Hill, MD
Dermatology
NPI 1992118434
7767 W DEER VALLEY RD STE 140
Peoria, AZ 85382
(623) 487-3003
✔ PECOS✔ Accepts MedicareSame address
Jennifer Rorex, MD
Dermatology
NPI 1447875372
7767 W DEER VALLEY RD STE 140
Peoria, AZ 85382
(623) 487-3003
✔ PECOS✔ Accepts MedicareSame address
Ryan Stevens, M.D.
Dermatology
NPI 1417279068
18699 N 67TH AVE STE 220
Glendale, AZ 85308
(480) 905-8485
✔ PECOS✔ Accepts Medicare2.3 mi
Julie Jacobs, D.O.
Dermatology
NPI 1336341650
14155 N 83RD AVE STE 110
Peoria, AZ 85381
(623) 888-8145
✔ PECOS✔ Accepts Medicare4.7 mi
Jennifer Aronica, M.D.
Dermatology
NPI 1699160697
2525 W CAREFREE HWY STE 144
Phoenix, AZ 85085
(623) 487-3003
✔ PECOS✔ Accepts Medicare10 mi
Thomas Lee
Dermatology
NPI 1396122727
2525 W CAREFREE HWY STE 144
Phoenix, AZ 85085
(623) 487-3003
✔ PECOS10 mi
Morgan Mackey, D.O.
Dermatology
NPI 1699087809
9327 N 3RD ST STE 206
Phoenix, AZ 85020
(602) 944-4626
✔ PECOS✔ Accepts Medicare12 mi
Nor Chiao, M.D., J.D., LL.M.
Dermatology
NPI 1841223583
9520 W PALM LN STE 115
Phoenix, AZ 85037
(480) 556-0446
✔ PECOS15 mi
Lisa Hynes, M.D.
Dermatology
NPI 1083661474
10750 W MCDOWELL RD BLDG. D STE. 400
Avondale, AZ 85323
(623) 889-2516
✔ PECOS15 mi
Bianca Kang, MD
Dermatology
NPI 1174260822
5777 E MAYO BLVD
Phoenix, AZ 85054
(480) 515-6296
✔ PECOS✔ Accepts Medicare16 mi
Scott Whitlock, MD
Dermatology
NPI 1992237473
20800 W MARKET ST STE 111
Buckeye, AZ 85396
(623) 624-7200
✔ PECOS✔ Accepts Medicare22 mi
Sarah Smith, MD
Dermatology
NPI 1518661040
13400 E SHEA BLVD
Scottsdale, AZ 85259
(480) 301-8000
✔ PECOS✔ Accepts Medicare26 mi
Rita Fisler, M.D.
Dermatology
NPI 1134192859
15215 S 48TH ST STE 120
Phoenix, AZ 85044
(480) 706-6580
✔ PECOS✔ Accepts Medicare29 mi
Bridget Shaw, MSN, APRN, FNP-C
Nurse Practitioner
NPI 1285204719
5980 N LA CHOLLA BLVD
Tucson, AZ 85741
(520) 887-3361
✔ PECOS✔ Accepts Medicare118 mi
Aleksi Hendricks, MD
Dermatology
NPI 1265060776
5150 E GLENN ST
Tucson, AZ 85712
(520) 795-7729
✔ PECOS✔ Accepts Medicare125 mi
Alexander Rose, MD
Dermatology
NPI 1376293761
6648 E CARONDELET DR
Tucson, AZ 85710
(520) 886-8151
✔ PECOS✔ Accepts Medicare128 mi
Latha Vellanki, M.D.
Dermatology
NPI 1346332640
6648 E CARONDELET DR
Tucson, AZ 85710
(520) 886-8151
✔ PECOS✔ Accepts Medicare128 mi
Andrew Tedesco, M.D.
Dermatology
NPI 1235128851
6648 E CARONDELET DR
Tucson, AZ 85710
(520) 886-8151
128 mi
David Seiter
Nurse Practitioner
NPI 1891190567
5512 E MAIN ST STE A
Farmington, NM 87402
(505) 787-2515
✔ PECOS✔ Accepts Medicare314 mi
See all 31 clinicians

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 3

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 03D0957147

Epiphany Dermatology Of Arizona, LLC · Peoria, AZ
Active · expires Dec 9, 2027
CLIA Number03D0957147
Laboratory TypePhysician Office
Certificate Effective DateDecember 10, 2025
Certificate Expiration DateDecember 9, 2027
Laboratory DirectorDane Hill
Laboratory Phone(623) 487-3003
Laboratory LocationEpiphany Dermatology Of Arizona, LLC7767 W Deer Valley Rd, Ste #140, Peoria, AZ 85382
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 for Provider-Performed Microscopy Procedures (PPMP) 03D2150221

Epiphany Dermatology Of Arizona, LLC · Avondale, AZ
Active · expires Jun 18, 2028
CLIA Number03D2150221
Laboratory TypePhysician Office
Certificate Effective DateJune 19, 2026
Certificate Expiration DateJune 18, 2028
Laboratory DirectorKeith J. Haar
Laboratory Phone(623) 487-3003
Laboratory LocationEpiphany Dermatology Of Arizona, LLC10750 W Mcdowell Rd Ste D-400, Avondale, AZ 85392
CLIA data matches this NPI record on: 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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 03D2056360

Epiphany Dermatology Of Arizona, LLC · Phoenix, AZ
Active · expires Sep 25, 2027
CLIA Number03D2056360
Laboratory TypePhysician Office
Certificate Effective DateSeptember 26, 2025
Certificate Expiration DateSeptember 25, 2027
Laboratory DirectorJanessa R. England
Laboratory Phone(623) 487-3003
Laboratory LocationEpiphany Dermatology Of Arizona, LLC2525 E Carefree Hwy, Ste 144, Phoenix, AZ 85085
CLIA data matches this NPI record on: 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 Epiphany Dermatology Of Arizona, LLC's NPI number?

The NPI number for Epiphany Dermatology Of Arizona, LLC is 1457465858. It was assigned to this organization in the NPPES registry on August 19, 2006.

Where is Epiphany Dermatology Of Arizona, LLC located?

Epiphany Dermatology Of Arizona, LLC is located at 7767 W Deer Valley Rd Suite 140, Peoria, AZ 85382. The listed phone number is (623) 487-3003.

What is Epiphany Dermatology Of Arizona, LLC's specialty?

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

Is Epiphany Dermatology Of Arizona, LLC enrolled in Medicare?

Yes. Epiphany Dermatology Of Arizona, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Epiphany Dermatology Of Arizona, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 31 clinicians in 2 Medicare specialties reassign their Medicare billing to Epiphany Dermatology Of Arizona, LLC. 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 (29) and Nurse Practitioner (2). Of these, 3 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Epiphany Dermatology Of Arizona, LLC hold CLIA laboratory certificates?

Yes. 3 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 Epiphany Dermatology Of Arizona, LLC accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health and Imperial Insurance Companies, Inc. list Epiphany Dermatology Of Arizona, LLC 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 Epiphany Dermatology Of Arizona, LLC was last updated on December 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.