Active NPI
Mikel W Skousen, DO
- Family Medicine Physician
- Mesa, AZ
National Provider Identifier
1457458358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1213
- Practice address
- 457 E 4TH Place
Mesa, AZ 85203 - Phone
- (480) 833-5383
- Fax
- (480) 833-5385
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1213 | AZ | Primary |
Addresses
Primary practice location
457 E 4TH Place
Mesa, AZ 85203
Mailing address
457 E 4TH PL
Mesa, AZ 85203-7154
Phone (480) 833-5383
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 237190-01 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1213 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376524800000",
"number": "1457458358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "457 E 4TH PL",
"city": "MESA",
"state": "AZ",
"postal_code": "852037154",
"telephone_number": "480-833-5383",
"fax_number": "480-833-5385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "457 E 4TH PLACE",
"city": "MESA",
"state": "AZ",
"postal_code": "85203",
"telephone_number": "480-833-5383",
"fax_number": "480-833-5385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKOUSEN",
"first_name": "MIKEL",
"middle_name": "W",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2013-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "1213",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "237190-01",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.