NPIMap

Organization Active NPI

Flagstaff Surgical Associates PA

  • Surgical Critical Care Physician
  • Flagstaff, AZ
National Provider Identifier
1114995271
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
Legal business name
FLAGSTAFF SURGICAL ASSOCIATES PA
Practice address
77 W Forest Ave Ste 201
Flagstaff, AZ 86001-1483
Phone
(928) 773-2222
Fax
(928) 773-2598
NPI assigned
Mar 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Authorized official

Name
Daniel Lee Wilson
Title
Manager
Phone
(928) 773-2572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0102X Primary

Addresses

Primary practice location

77 W Forest Ave Ste 201
Flagstaff, AZ 86001-1483

Mailing address

77 W Forest Ave Ste 201
Flagstaff, AZ 86001-1483
Phone (928) 773-2222

Other practice location 1

77 W Forest Ave Ste 212
Flagstaff, AZ 86001-1481
Phone (928) 773-2222 ext. 5

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615000876 AZ Part B Supplier - Clinic/Group Practice 6901880210 Receives reassigned benefits from 36 practitioners
Practice locations: Flagstaff, AZ

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1103484Flagstaff Surgical Associates77 W Forest Ave Suite 201, Flagstaff, AZ 86001Certificate of waiverNov 30, 2026

National Provider Directory

National Provider Directory

Locations

77 W Forest Ave
Ste 305
Flagstaff, AZ 86001
Phone (480) 229-8068

77 W Forest Ave
Ste 107
Flagstaff, AZ 86001
Phone (520) 773-2530

560 N Switzer Canyon Dr
Flagstaff, AZ 86001
Phone (928) 774-3044

77 W Forest Ave
Ste 201
Flagstaff, AZ 86001
Phone (928) 773-2222

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BJDHBD

Practitioners & affiliated clinicians

Practitioners 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1114995271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W FOREST AVE STE 201",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011483",
            "telephone_number": "928-773-2222",
            "fax_number": "928-773-2598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W FOREST AVE STE 201",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011483",
            "telephone_number": "928-773-2222",
            "fax_number": "928-773-2598"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 W Forest Ave Ste 212",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860011481",
            "country_code": "US",
            "telephone_number": "928-773-2222 x5",
            "fax_number": "928-773-2598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FLAGSTAFF SURGICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "928-773-2572"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.