NPIMap

Organization Active NPI

Arizona Skin and Laser Therapy Institute, LTD.

Doing business as Arizona Dermatology

  • Dermatology Physician
  • Sun Lakes, AZ
National Provider Identifier
1467759274
Registry record updated Feb 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD.
Doing business as
Arizona Dermatology
Practice address
10440 E Riggs Rd
Suite 209
Sun Lakes, AZ 85248-7751
Phone
(480) 818-3314
NPI assigned
Feb 15, 2011
Last updated
Feb 15, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
ARIZONA SKIN AND LASER THERAPY INSITUTE, LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 15, 2011

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

Authorized official

Name
Neil P Superfon, DO
Title
Owner/Physician
Phone
(602) 277-2247

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

10440 E Riggs Rd
Suite 209
Sun Lakes, AZ 85248-7751

Mailing address

2224 W Northern Ave
Suite D-300
Phoenix, AZ 85021-4928
Phone (602) 277-1449

Other names 1

  • Arizona Dermatology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000424 AZ Part B Supplier - Clinic/Group Practice 6204720626 Receives reassigned benefits from 17 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Apache Junction, AZ; Coolidge, AZ; Gilbert, AZ; Mesa, AZ; Phoenix, AZ; Quartzsite, AZ; Scottsdale, AZ; Show Low, AZ

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Arizona Skin Laser Therapy

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297728000000",
    "number": "1467759274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 W NORTHERN AVE",
            "address_2": "SUITE D-300",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214928",
            "telephone_number": "602-277-1449",
            "fax_number": "602-277-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10440 E RIGGS RD",
            "address_2": "SUITE 209",
            "city": "SUN LAKES",
            "state": "AZ",
            "postal_code": "852487751",
            "telephone_number": "480-818-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARIZONA SKIN AND LASER THERAPY INSITUTE, LTD",
        "enumeration_date": "2011-02-15",
        "last_updated": "2011-02-15",
        "status": "A",
        "authorized_official_last_name": "SUPERFON",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "602-277-2247",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sun Lakes, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.