Active NPI
Walter J Lewis, M.D.
- Dermatology Physician
- Goodyear, AZ
National Provider Identifier
1013044999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 40648
- Practice address
- 14537 W Indian School Rd
#700
Goodyear, AZ 85395-9243 - Phone
- (623) 935-0247
- Fax
- (623) 974-9351
- NPI assigned
- Feb 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 40648 | AZ | Primary |
Addresses
Primary practice location
14537 W Indian School Rd
#700
Goodyear, AZ 85395-9243
Mailing address
13943 N 91 Avenue
C-101
Peoria, AZ 85381-3629
Phone (623) 760-9449
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4Z2980 | Other | AZ | HEALTH NET |
| 608299 | Other | AZ | AHCCCS |
| 608299 | Medicaid | AZ | |
| P00725809 | Other | AZ | RAILROAD MEDICARE |
| 1081859 | Other | AZ | UNITED HEALTHCARE |
| 608299 | Other | AZ | AETNA |
| 1013044999 | Other | AZ | BLUE CROSS BLUE SHIELD |
| 1013044999 | Other | AZ | TRICARE |
| 40648 | Other | AZ | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380844800000",
"number": "1013044999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13943 N 91 AVENUE",
"address_2": "C-101",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853813629",
"telephone_number": "623-760-9449",
"fax_number": "623-974-9351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14537 W INDIAN SCHOOL RD",
"address_2": "#700",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853959243",
"telephone_number": "623-935-0247",
"fax_number": "623-974-9351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "WALTER",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2013-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "AZ",
"license": "40648",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "4Z2980",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "608299",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "608299",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00725809",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1081859",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "608299",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1013044999",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "1013044999",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "40648",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.