NPIMap

Organization Active NPI

Camelback Dermatology & Skin Surgery, Inc

  • Dermatology Physician
  • Phoenix, AZ
National Provider Identifier
1225175441
Registry record updated Nov 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
31198 Issued in AZ
Legal business name
CAMELBACK DERMATOLOGY & SKIN SURGERY, INC
Practice address
4512 N 40TH St
Phoenix, AZ 85018-3600
Phone
(602) 954-7546
Fax
(602) 952-2941
NPI assigned
Jan 30, 2007
Last updated
Nov 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2014

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

Authorized official

Name
Jeffrey Lee Romine
Title
Practice Administrator
Phone
(602) 954-7546

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 31198 AZ Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X 31198 AZ
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X 31198 AZ

Addresses

Primary practice location

4512 N 40TH St
Phoenix, AZ 85018-3600

Mailing address

4512 N 40TH St
Phoenix, AZ 85018-3600
Phone (602) 954-7546

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
03D1011584Camelback Dermatology & Skin Surgery4512 North 40TH St, Phoenix, AZ 85018ComplianceMar 9, 2028

National Provider Directory

National Provider Directory

Locations

4350 E Camelback Rd
Ste A200
Phoenix, AZ 85018
Phone (602) 954-7546

4512 N 40th St
Phoenix, AZ 85018
Phone (602) 954-7546

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415923200000",
    "number": "1225175441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4512 N 40TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183600",
            "telephone_number": "602-954-7546",
            "fax_number": "602-952-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4512 N 40TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183600",
            "telephone_number": "602-954-7546",
            "fax_number": "602-952-2941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELBACK DERMATOLOGY & SKIN SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2014-11-14",
        "status": "A",
        "authorized_official_last_name": "ROMINE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "602-954-7546"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "31198",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "31198",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "31198",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.