Desert Mountain Skin Cancer Surgery, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

MD2011-0829 Issued in NM

Legal business name

DESERT MOUNTAIN SKIN CANCER SURGERY, LLC

Practice address

2019 Galisteo Street
Suite N-9B
Santa Fe, NM 87505

Phone

(505) 980-8738

Fax

(505) 404-8423

NPI assigned

Nov 4, 2016

Organization subpart

No

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

Authorized official

Name

Diane Marie Reisinger, M.D.

Title

Physician

Phone

(505) 980-8738

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Ellen Fertig, PA-C

  • Physician Assistant
  • Santa Fe, NM
  • NPI 1700308871
  NPD
• Beth A Jester, MD

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1548260995
  NPD

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1104378314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604",
            "city": "PLACITAS",
            "state": "NM",
            "postal_code": "870430604",
            "telephone_number": "505-980-8738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 GALISTEO STREET",
            "address_2": "SUITE N-9B",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87505",
            "telephone_number": "505-980-8738",
            "fax_number": "505-404-8423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT MOUNTAIN SKIN CANCER SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "REISINGER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "505-980-8738",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NM",
            "license": "MD2011-0829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003975699",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Department of Health, Public Health Division
• Department of Health, Public Health Division
• Dermatology of Santa Fe PC
• Dermatology Partners of Northern New Mexico
• Kendall Derosso
• Desert Rain Chiropractic
• Desert Rain Midwifery, LLC
• Desert Resilience Counseling LLC
• Desert Sky Wellness LLC
• Cyndi Desha

• All providers in Santa Fe, NM
• MOHS-Micrographic Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.