NPIMap

Organization Active NPI

The Center for Advanced Dermatology, P.C.

  • Dermatology Physician
  • Phoenix, AZ
National Provider Identifier
1750470175
Registry record updated Jan 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
20919 Issued in AZ
Legal business name
THE CENTER FOR ADVANCED DERMATOLOGY, P.C.
Practice address
4530 E Shea Blvd
Suite 101
Phoenix, AZ 85028
Phone
(602) 867-7546
Fax
(602) 971-0065
NPI assigned
Oct 12, 2006
Last updated
Jan 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2015

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

Authorized official

Name
Adriana Kay Holy, M.D.NPI 1750575643
Title
President
Phone
(602) 867-7546

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 20919 AZ
Dermatology Physician 207N00000X 20919 AZ Primary

Addresses

Primary practice location

4530 E Shea Blvd
Suite 101
Phoenix, AZ 85028

Mailing address

4530 E Shea Blvd.
Suite 101
Phoenix, AZ 85028
Phone (602) 867-7546

Other names 1

  • Adriana K Holy MD PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050923000886 AZ Part B Supplier - Clinic/Group Practice 9436183852 Receives reassigned benefits from 2 practitioners
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Locations

4530 E Shea Blvd
Ste 101
Phoenix, AZ 85028
Phone (602) 867-7546

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": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421020800000",
    "number": "1750470175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 E SHEA BLVD.",
            "address_2": "SUITE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85028",
            "telephone_number": "602-867-7546",
            "fax_number": "602-971-0065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 E SHEA BLVD",
            "address_2": "SUITE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85028",
            "telephone_number": "602-867-7546",
            "fax_number": "602-971-0065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR ADVANCED DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2015-01-12",
        "status": "A",
        "authorized_official_last_name": "HOLY",
        "authorized_official_first_name": "ADRIANA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-867-7546",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "20919",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "20919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adriana K Holy MD PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; 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.