EPIPHANY DERMATOLOGY OF MINNESOTA, LLC – Dermatology Physician, NPI 1356431191
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for EPIPHANY DERMATOLOGY OF MINNESOTA, LLC
20520 Keokuk Ave Ste 104
Lakeville, MN 550446085
Phone: (952) 469-5033
Fax: (952) 469-5069
Type: Location
Ekko Avenue, Albert Lea, Freeborn County, Minnesota, 56007, United States
ALBERT LEA, MN 560071800
Phone: (507) 373-2270
Fax: (507) 373-0363
Type: Location
7300 RANCH RD. 2222, BLDG 1, STE 200
AUSTIN, TX 787302309
Phone: (512) 628-0465
Fax: (512) 628-0468
Type: Mailing
Vaught Ranch Road, Austin, Travis County, Texas, 78730, United States
AUSTIN, TX 787302309
Phone: (512) 628-0465
Fax: (512) 628-0468
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2006-10-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-07-31 (679 days ago).
Enrollment records
1
Earliest due date
2024-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20061023000236 | O | Clinic/Group Practice | MN | 2024-07-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55044)
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