Sudheer J. Surpure, MD, DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

A92044 Issued in CA

Practice address

1600 W University Ave Ste 101
Flagstaff, AZ 86001-3154

Phone

(928) 247-6200

Fax

(702) 472-8575

NPI assigned

Oct 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Vanderbilt University School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sudheer J Surpure MD DDS Inc

  dba Grand Canyon Oral and Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Flagstaff, AZ
  • NPI 1023609062
  Medicare reassignment NPD Authorized official
• Sudheer J. Surpure, MD, DDS, Inc.

  dba Grand Canyon Oral and Facial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Henderson, NV
  • NPI 1447857024
  NPD Authorized official
• Jack a Buhrow DDS Ms PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Phoenix, AZ
  • NPI 1154596187
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Flagstaff Medical Center

  dba Guardian Air

  • Air Ambulance
  • Flagstaff, AZ
  • NPI 1427234111

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  dba Guardian Medical Transport

  • Land Ambulance
  • Flagstaff, AZ
  • NPI 1518143205

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  dba FMC Behavioral Health Services

  • Psychiatric Hospital Unit
  • Flagstaff, AZ
  • NPI 1649370875
  Care Compare affiliation
• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078
  Care Compare affiliation

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1235216185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W UNIVERSITY AVE STE 101",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013154",
            "telephone_number": "928-247-6200",
            "fax_number": "602-957-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W UNIVERSITY AVE STE 101",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013154",
            "telephone_number": "928-247-6200",
            "fax_number": "702-472-8575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 W Sunset Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890142655",
            "country_code": "US",
            "telephone_number": "702-992-7907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SURPURE",
        "first_name": "SUDHEER",
        "middle_name": "J.",
        "credential": "MD, DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "OMS 89",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "OMFS SPECIALTY 157",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "AZ",
            "license": "41157",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "A92044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A920440",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amber Elaine Swain, M.S. CCC-SLP

• Oral & Maxillofacial Surgery (D.M.D.) in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.