EPIPHANY DERMATOLOGY OF WASHINGTON PLLC
NPI 1053142778
Dermatology in Mercer Island, WA

NPI Status: Active since August 13, 2024

Contact Information

7707 SE 27TH ST STE 104
MERCER ISLAND, WA
ZIP 98040
Phone: (512) 628-0465

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  • Organization
  • Dermatology
  • CLIA Number: 50D2317185
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 04-04-2028

About EPIPHANY DERMATOLOGY OF WASHINGTON PLLC

This page provides the complete NPI Profile along with additional information for Epiphany Dermatology Of Washington Pllc, a provider established in Mercer Island, Washington operating as a Dermatology. The healthcare provider is registered in the NPI registry with number 1053142778 assigned on August 2024. The practitioner's primary taxonomy code is 207N00000X. The provider is registered as an organization and their NPI record was last updated one year ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Gheorghe Pusta (Executive Director)

NPI
1053142778
Provider Name
EPIPHANY DERMATOLOGY OF WASHINGTON PLLC
Entity Type
Organization
Location Address
7707 SE 27TH ST STE 104 MERCER ISLAND, WA 98040
Location Phone
(512) 628-0465
Mailing Address
7300 RANCH ROAD 2222, BLDG 1, STE 200 AUSTIN, TX 78730
Mailing Phone
(512) 628-0465
Mailing Fax
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
08-13-2024
Last Update Date
08-13-2024
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A dermatologist like Epiphany Dermatology Of Washington Pllc is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.

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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Dermatology

Taxonomy Code
207N00000X
Type
Allopathic & Osteopathic Physicians
Taxonomy Description
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.

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

GHEORGHE PUSTA

Authorized Official Title
EXECUTIVE DIRECTOR
Authorized Official Phone
(512) 628-0465

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
50D2317185
Facility Type
Physician Office
Certificate Effective Date
January 28, 2025
Certificate Expiration Date
April 04, 2028
Laboratory Director
KELLY A. GRIFFITH-BAUER
Certificate Type
Certificate of Compliance
Certificate Type Description
This CLIA certificate is issued to Epiphany Dermatology Of Washington Pllc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1053142778
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
20103244714
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 1 + 0 + 3 + 2 + 4 + 4 + 7 + 1 + 4 + 24 = 52
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 52 = 88

The NPI number 1053142778 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1124037817DR. BRENDA L NEWMAN M.D., PH.D.
Individual
Dermatology7707 SE 27TH ST STE 104
MERCER ISLAND, WA 98040
(206) 232-2267
1740338102 RACHEL A. GARTON M.D.
Individual
Dermatology7707 SE 27TH ST STE 104
MERCER ISLAND, WA 98040
(206) 232-2267

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1053142778, enumerated in the NPI registry as an "organization" on August 13, 2024

The provider is located at 7707 Se 27th St Ste 104 Mercer Island, Wa 98040 and the phone number is (512) 628-0465

This medical organization specializes in Dermatology with taxonomy code 207N00000X

The provider's CLIA number is 50D2317185 for a "physician office" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing..

This NPI record was last updated on August 13, 2024. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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