Organization Active NPI

Phoenix Skin II PC

  • Dermatology Physician
  • Phoenix, AZ
National Provider Identifier
1609078997
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PHOENIX SKIN II PC
Practice address
5056 N Central Ave
Phoenix, AZ 85012-1521
Phone
(602) 222-9111
Fax
(602) 277-5111
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Authorized official

Name
Dr. Lee P Laris, DONPI 1649274671
Title
Physician
Phone
(602) 222-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

5056 N Central Ave
Phoenix, AZ 85012-1521

Mailing address

5056 N Central Ave
Phoenix, AZ 85012-1521
Phone (602) 222-9111

Other names 1

  • Phoenix Skin Medical Surgical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040521000007 AZ Part B Supplier - Clinic/Group Practice 8123019833 Receives reassigned benefits from 12 practitioners
Practice locations: Scottsdale, AZ; Phoenix, AZ

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2001285Phoenix Skin Medical Surgical Group5056 N Central Avenue, Phoenix, AZ 85012ComplianceMar 8, 2027

National Provider Directory

National Provider Directory

Locations

5060 N Central Ave
Phoenix, AZ 85012

5056 N Central Ave
Phoenix, AZ 85012
Phone (602) 222-9111

7312 E Deer Valley Rd
Ste 105
Scottsdale, AZ 85255

7312 E Deer Valley Rd
Ste D105
Scottsdale, AZ 85255
Phone (480) 473-9111

7014 E Camelback Rd
Ste 1004
Scottsdale, AZ 85251

7014 E Camelback Rd
#1004
Scottsdale, AZ 85251
Phone (480) 425-9111

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1609078997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5056 N CENTRAL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121521",
            "telephone_number": "602-222-9111",
            "fax_number": "602-277-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5056 N CENTRAL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121521",
            "telephone_number": "602-222-9111",
            "fax_number": "602-277-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SKIN II PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "LARIS",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "602-222-9111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Skin Medical Surgical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.