Arizona Associates in Dermatology and Cosmetic Surgery, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ARIZONA ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY, LLC

Practice address

830 Ainsworth Dr
Prescott, AZ 86301-1630

Phone

(928) 776-0325

Fax

(928) 776-0405

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Amy Fajardo

Title

Billing/Credentialing

Phone

(928) 777-5807

Specialties & licenses 7

Addresses

Other names 1

• Arizona Dermatology Group Doing business as

Locations

Practitioners 30

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

• Darek Anderson, P.A.-C

  • Physician Assistant
  • Tucson, AZ
  • NPI 1518932136
  NPD
• Emily Brewton, PA-C

  • Physician Assistant
  • Prescott, AZ
  • NPI 1255701801
  NPD
• John ZS Chen, M.D., FAAD

  • MOHS-Micrographic Surgery Physician
  • Tucson, AZ
  • NPI 1942209887

  Dermatology

  NPD
• Stephen Troy Cox, PAC

  • Medical Physician Assistant
  • Tucson, AZ
  • NPI 1295915353
  NPD
• Elka R. Eisen, M.D., FAAD

  • Dermatology Physician
  • Tucson, AZ
  • NPI 1265431274

  Dermatology

  NPD
• Noelle Eskandari

  • Physician Assistant
  • Tucson, AZ
  • NPI 1154750941

  Dermatology

  NPD
• Kirsten Flynn, MD

  • Dermatology Physician
  • Prescott, AZ
  • NPI 1558371179

  Dermatology

  NPD
• Cacie Lee Goetz-Campos, MSN, FNP-C

  • Nurse Practitioner
  • Prescott, AZ
  • NPI 1700537321
  NPD
• Mark Gruszynski, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Paradise Valley, AZ
  • NPI 1396188033

  Plastic Surgery

  NPD
• Cennia Nicole Hernandez, PA-C

  • Physician Assistant
  • Tucson, AZ
  • NPI 1306275037
  NPD
• Kasey Hollandsworth, PA-C

  • Physician Assistant
  • Tucson, AZ
  • NPI 1356894554
  NPD
• Sandra-Lynn Frances Hutchison, P.A.

  • Physician Assistant
  • Prescott, AZ
  • NPI 1497761332
  NPD

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1659467397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 AINSWORTH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011630",
            "telephone_number": "928-776-0325",
            "fax_number": "928-776-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 AINSWORTH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011630",
            "telephone_number": "928-776-0325",
            "fax_number": "928-776-0405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "203 S Candy Ln Ste 14",
            "address_purpose": "LOCATION",
            "city": "Cottonwood",
            "state": "AZ",
            "postal_code": "863264120",
            "country_code": "US",
            "telephone_number": "928-639-3387",
            "fax_number": "928-634-0311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 N Glassford Hill Rd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "863142256",
            "country_code": "US",
            "telephone_number": "928-772-8553",
            "fax_number": "928-772-3861",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18325 N Allied Way Ste 120",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850543107",
            "country_code": "US",
            "telephone_number": "928-776-0325",
            "fax_number": "928-776-0405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ARIZONA ASSOCIATES IN DERMATOLOGY AND COSMETIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING",
        "authorized_official_telephone_number": "928-777-5807"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "29683",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "29683",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "AZ",
            "license": "29683",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "29683",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "AZ",
            "license": "48829",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arizona Dermatology Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.