NPIMap

Organization Active NPI

Arizona Skin and Laser Therapy Institute, LTD

  • Dermatology Physician
  • Mesa, AZ
National Provider Identifier
1659829109
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD
Practice address
6644 E Baseline Rd
Mesa, AZ 85206-4438
Phone
(480) 844-0510
Fax
(602) 277-9984
NPI assigned
Sep 13, 2016
Last updated
Sep 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

6644 E Baseline Rd
Mesa, AZ 85206-4438

Mailing address

2224 W Northern Ave
Suite D300
Phoenix, AZ 85021-4928
Phone (602) 277-1449

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
Tax ID family
Arizona Skin Laser Therapy3 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

6644 E Baseline Rd
Mesa, AZ 85206
Phone (480) 321-2222

6644 E Baseline Rd
Ste 102
Mesa, AZ 85206
Phone (480) 844-0510

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473724800000",
    "number": "1659829109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 W NORTHERN AVE",
            "address_2": "SUITE D300",
            "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": "6644 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064438",
            "telephone_number": "480-844-0510",
            "fax_number": "602-277-9984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA SKIN AND LASER THERAPY INSTITUTE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-13",
        "last_updated": "2016-09-13",
        "status": "A",
        "authorized_official_last_name": "SUPERFON",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "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": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; 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.