Individual provider Active NPI

William Goin Anderson, DO

  • Dermatology Physician
  • Lake Havasu City, AZ
National Provider Identifier
1710056221
Registry record updated Feb 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
3015 Issued in AZ
Practice address
2061 Smoketree Avenue
Lake Havasu City, AZ 86403
Phone
(928) 453-3332
Fax
(928) 453-1590
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 3015 AZ Primary

Addresses

Primary practice location

2061 Smoketree Avenue
Lake Havasu City, AZ 86403

Mailing address

2061 Smoketree Avenue
Lake Havasu City, AZ 86403
Phone (928) 453-3332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050718000095 AZ Practitioner - Dermatology 4183650542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arizona Desert Dermatology and Surgery PCGroup PAC ID 6305732512, 11 clinicians

Practice addresses (Care Compare)

2091 N Smoketree Ave
Suite 103
Lake Havasu City, AZ 86403-5896
Phone (928) 453-3332

Merit-based Incentive Payment System (MIPS)

Final score
92.68 of 100Reported as individual
Quality
90.62
Promoting interoperability
100
Improvement activities
40
Cost
84.96

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision128
Removal of skin lesions3100
Removal of skin cancer118
Removal or shaving of skin growth12
Skin biopsy524

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
3015AZMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Desert Dermatology and Surgery PC Dermatology CurrentSince Jan 1, 1997 Accepting new patients

Locations

3015 Highway 95
Ste 110
Bullhead City, AZ 86442
Phone (928) 758-8885

1700 Sycamore Ave
Ste 1
Kingman, AZ 86409
Phone (928) 692-8885

1700 Sycamore Ave
Kingman, AZ 86409
Phone (928) 692-8885

2061 Smoketree Ave N
Lake Havasu City, AZ 86403
Phone (928) 452-3332

2091 Smoketree Ave N
Ste 103
Lake Havasu City, AZ 86403
Phone (928) 453-3332

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202342400000",
    "number": "1710056221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2061 SMOKETREE AVENUE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-453-3332",
            "fax_number": "928-453-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2061 SMOKETREE AVENUE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-453-3332",
            "fax_number": "928-453-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "WILLIAM",
        "middle_name": "GOIN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "3015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

Verify at the official NPI Registry.