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

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.

• 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
• Elsadig Mahmoud Omer
• Omni Dermatology Olive LLC
• Oluwatoyosi Dada Omojaro, M.D.
• Victoria Omutsani, PHARMD
• On Call Dental LLC
• 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.