Phoenix Surgical Dermatology Group LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

PHOENIX SURGICAL DERMATOLOGY GROUP LLC

Practice address

4550 E Bell Rd BLDG 5
Phoenix, AZ 85032-9390

Phone

(480) 666-5568

Fax

(702) 297-6238

NPI assigned

Feb 24, 2020

Last updated

Feb 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ramin Fathi, MDNPI 1215374186

Title

Owner

Phone

(480) 666-5568

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00235

Practitioners 3

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.

• Ramin Fathi, MD

  • MOHS-Micrographic Surgery Physician
  • Scottsdale, AZ
  • NPI 1215374186

  Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Colleen M Luna, MD

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1861072654
  Medicare reassignment Care Compare group NPD
• Brent Drew Sloten, DO

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1073585402
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1582502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582934400000",
    "number": "1447884929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 E BELL RD BLDG 5",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850329390",
            "telephone_number": "480-666-5568",
            "fax_number": "702-297-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 E BELL RD BLDG 5",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850329390",
            "telephone_number": "480-666-5568",
            "fax_number": "702-297-6238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SURGICAL DERMATOLOGY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-24",
        "last_updated": "2020-02-29",
        "certification_date": "2020-02-29",
        "status": "A",
        "authorized_official_last_name": "FATHI",
        "authorized_official_first_name": "RAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-666-5568",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• MOHS-Micrographic Surgery Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• MOHS-Micrographic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2020; 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.