NPIMap

Organization Active NPI

Richard Lee Averitte Jr PLLC

Doing business as Affiliated Dermatology

  • Dermatology Physician
  • Phoenix, AZ
National Provider Identifier
1609291848
Registry record updated Feb 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
40537 Issued in AZ
Legal business name
RICHARD LEE AVERITTE JR PLLC
Doing business as
Affiliated Dermatology
Practice address
19646 N 27TH Ave
Ste 305
Phoenix, AZ 85027-4017
Phone
(480) 556-0446
NPI assigned
Feb 25, 2014
Last updated
Feb 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2014

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

Authorized official

Name
Marlie Averitte
Title
Cfo
Phone
(480) 556-0446

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 40537 AZ Primary
MOHS-Micrographic Surgery Physician 207ND0101X 40537 AZ
Dermatopathology Physician 207ND0900X 40537 AZ
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X 40537 AZ
Pediatric Dermatology Physician 207NP0225X 40537 AZ
Procedural Dermatology Physician 207NS0135X 40537 AZ

Addresses

Primary practice location

19646 N 27TH Ave
Ste 305
Phoenix, AZ 85027-4017

Mailing address

20401 N 73Rd St
Ste 230
Scottsdale, AZ 85255-4107
Phone (480) 556-0446

Other names 1

  • Affiliated Dermatology Doing business as

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
03D1097352Richard Lee Averitte Jr PLLC19646 N 27TH Ave, Ste 305, Phoenix, AZ 85027ComplianceFeb 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
Affiliated Dermatology3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

19646 N 27th Ave
Ste 305
Phoenix, AZ 85027

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393286400000",
    "number": "1609291848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20401 N 73RD ST",
            "address_2": "STE 230",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852554107",
            "telephone_number": "480-556-0446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19646 N 27TH AVE",
            "address_2": "STE 305",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850274017",
            "telephone_number": "480-556-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD LEE AVERITTE JR PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-25",
        "last_updated": "2014-02-25",
        "status": "A",
        "authorized_official_last_name": "AVERITTE",
        "authorized_official_first_name": "MARLIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "480-556-0446"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "40537",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "40537",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "AZ",
            "license": "40537",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "AZ",
            "license": "40537",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "AZ",
            "license": "40537",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "40537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Affiliated Dermatology",
            "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 Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.