Omni Dermatology Incorporated

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4311 Issued in AZ

Legal business name

OMNI DERMATOLOGY INCORPORATED

Practice address

11851 N 51St Ave Ste E130
Glendale, AZ 85304-2843

Phone

(480) 954-3919

Fax

(480) 954-3670

NPI assigned

Apr 30, 2008

Last updated

Apr 3, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrew J Racette, D.O.NPI 1447429097

Title

President

Phone

(602) 369-3634

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6619/brand/1/csg/1/fhir/r4

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Joseph Racette, D.O.

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1447429097
  Medicare reassignment Care Compare group NPD Authorized official
• Jeffrey Dickman, DO

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1225598675
  Medicare reassignment Care Compare group NPD
• Anna Figueiredo, MD

  • Pediatric Dermatology Physician
  • Phoenix, AZ
  • NPI 1902435530
  Medicare reassignment Care Compare group NPD
• Derrek Giansiracusa

  • Dermatology Physician
  • Glendale, AZ
  • NPI 1154023737

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Diana Alexis Jimenez, FNP-C

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1215509336
  Medicare reassignment Care Compare group NPD
• Lindsey N Johnson, DO

  • Dermatology Physician
  • Glendale, AZ
  • NPI 1912696550
  Medicare reassignment Care Compare group NPD
• Erik Jason Martinez

  • Family Nurse Practitioner
  • Glendale, AZ
  • NPI 1225531551

  Dermatology

  Medicare reassignment Care Compare group NPD
• Melissa Martinez, FNP

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1437942828
  Medicare reassignment Care Compare group NPD
• Lidia Margarita Navarro, FNP-C

  • Family Nurse Practitioner
  • Surprise, AZ
  • NPI 1417428657
  Medicare reassignment Care Compare group NPD
• Michelle Shaughnessy, NP-C

  • Family Nurse Practitioner
  • Anthem, AZ
  • NPI 1326714874
  Medicare reassignment Care Compare group NPD
• Craig Angelo Wiggins, F.N.P.

  • Family Nurse Practitioner
  • Phoenix, AZ
  • NPI 1386088649

  Dermatology

  Medicare reassignment Care Compare group NPD
• Tana Frumento, PA-C

  • Physician Assistant
  • Phoenix, AZ
  • NPI 1972644532
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1003082090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11851 N 51ST AVE STE E130",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853042843",
            "telephone_number": "236-299-9540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11851 N 51ST AVE STE E130",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853042843",
            "telephone_number": "480-954-3919",
            "fax_number": "480-954-3670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI DERMATOLOGY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "RACETTE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-369-3634",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "4311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Olson
• Dale Albert Olson, COTA/L
• Mary Olson, PHARMD
• Olympic Ptwest at Arrowhead LLC (Olympic PTWest)
• Elsadig Mahmoud Omer
• Omni Dermatology Olive LLC
• Oluwatoyosi Dada Omojaro, M.D.
• Victoria Omutsani, PHARMD
• On Call Dental LLC (On Call Dental Urgent Care)
• On Point Podiatry PLLC

• Dermatology Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.