Omni Dermatology Tempe LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

OMNI DERMATOLOGY TEMPE LLC

Practice address

4515 S McClintock Dr
Ste 101
Tempe, AZ 85282-7376

Phone

(602) 559-5470

Fax

(602) 559-5471

NPI assigned

Nov 15, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Andrew Joseph Racette, D.O.NPI 1447429097

Title

President

Phone

(602) 559-9961

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Practitioners 1

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

• Andrew Joseph Racette, D.O.

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1447429097
  NPD Authorized official

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

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479168000000",
    "number": "1639611130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 E INDIAN SCHOOL RD",
            "address_2": "STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185500",
            "telephone_number": "602-559-9961",
            "fax_number": "602-954-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 S MCCLINTOCK DR",
            "address_2": "STE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827376",
            "telephone_number": "602-559-5470",
            "fax_number": "602-559-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI DERMATOLOGY TEMPE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2016-11-15",
        "status": "A",
        "authorized_official_last_name": "RACETTE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-559-9961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; 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.