Teton Dermatology LLC
NPI 1194044750ActiveOrganization· Dermatology· Jackson, WY
Dermatology in Jackson, Wyoming, registered in NPPES in May 2010. The authorized official on file is Gheorghe Pusta, Executive Director. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1194044750 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 21, 2010 |
| Last updated in NPPES | Sep 18, 2024 |
| Certified by provider | Sep 18, 2024 |
| Reactivated | Oct 7, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WY) |
|---|
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