NPIMap

Organization Active NPI

Dermatology & Skin Care by Shelly

Doing business as Dermatology by Shelly

  • Dermatology Physician
  • Chino Valley, AZ
National Provider Identifier
1720855141
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY & SKIN CARE BY SHELLY
Doing business as
Dermatology & Skin Care by Shelly
Dermatology by Shelly
Practice address
1598 Susan a Williams Way
Suite E
Chino Valley, AZ 86323-5957
Phone
(928) 499-2915
Fax
(877) 406-3180
NPI assigned
Dec 6, 2023
Last updated
Jul 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Authorized official

Name
Shelly Lynn Crossman, FNP-C, DCNPNPI 1295167484
Title
Provider/Owner
Phone
(928) 499-2915

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1598 Susan a Williams Way
Suite E
Chino Valley, AZ 86323-5957

Mailing address

PMB PO Box 416
1042 Willow Creek Rd Suite A101
Prescott, AZ 86301
Phone (928) 899-4455

Other names 2

  • Dermatology & Skin Care by Shelly Doing business as
  • Dermatology by Shelly Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240328003856 AZ Part B Supplier - Clinic/Group Practice 8921446725 Receives reassigned benefits from 1 practitioner
Practice locations: Chino Valley, AZ

National Provider Directory

National Provider Directory

Locations

1598 Susan a Williams Way
Ste E
Chino Valley, AZ 86323
Phone (928) 499-2915

448 N Highway 89
Chino Valley, AZ 86323

448 N State Route 89
Ste H
Chino Valley, AZ 86323
Phone (928) 499-2915

Practitioners & affiliated clinicians

Practitioners 2

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": "1701820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1720855141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PMB PO BOX 416",
            "address_2": "1042 WILLOW CREEK RD SUITE A101",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86301",
            "telephone_number": "928-899-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1598 SUSAN A WILLIAMS WAY",
            "address_2": "SUITE E",
            "city": "CHINO VALLEY",
            "state": "AZ",
            "postal_code": "863235957",
            "telephone_number": "928-499-2915",
            "fax_number": "877-406-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & SKIN CARE BY SHELLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-06",
        "last_updated": "2024-07-18",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "CROSSMAN",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "928-499-2915",
        "authorized_official_credential": "FNP-C, DCNP"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology & Skin Care by Shelly",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dermatology by Shelly",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dermatology by Shelly",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chino Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.