Jesse M Olmedo, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

30536 Issued in AZ

Practice address

14800 W Mountain View Blvd
Suite 160
Surprise, AZ 85374-2700

Phone

(623) 584-3376

Fax

(623) 584-3375

NPI assigned

May 3, 2006

Last updated

Apr 9, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 8

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

Dermatology

Education

Texas Tech University Health Science Center School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arizona Dermatology Specialists, PLLCGroup PAC ID 6204085145, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

20.77 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

69.23

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arizona Dermatology Specialists, PLLC

  • Dermatology Physician
  • Surprise, AZ
  • NPI 1992061162
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1265490429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14800 W MOUNTAIN VIEW BLVD",
            "address_2": "SUITE 160",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853744795",
            "telephone_number": "623-584-3376",
            "fax_number": "623-584-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14800 W MOUNTAIN VIEW BLVD",
            "address_2": "SUITE 160",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853742700",
            "telephone_number": "623-584-3376",
            "fax_number": "623-584-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLMEDO",
        "first_name": "JESSE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "30536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "1265490429",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2281872",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00234871",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0779550",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR WORK COMP",
            "identifier": "188961600",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7538647",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "2Z3349",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDISUN",
            "identifier": "99S007000011",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kalu Okorie
• Favour Nkiru Okwoli
• Vanessa R. Olds, PA-C
• Francisca Melissa Olibarria, FNP-C
• Augusta Ollech, PT, DPT
• Olosoma Therapy Services, Inc
• Darren Dee Olson, D.C.
• Jennifer Olson
• Shane Olson
• Omega Strategic Consulting

• Dermatology Physician in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; 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.