NPIMap

Organization Active NPI

Mesa Az Endoscopy ASC LLC

Doing business as Desert Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Mesa, AZ
National Provider Identifier
1770557233
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
OSC3651 Issued in AZ
Legal business name
MESA AZ ENDOSCOPY ASC LLC
Doing business as
Desert Endoscopy Center
Practice address
603 W Baseline Rd Ste 101
Mesa, AZ 85210-6050
Phone
(480) 969-0405
Fax
(480) 969-2280
NPI assigned
Feb 13, 2006
Last updated
Oct 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2021

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

Authorized official

Name
Samantha Dillon
Title
Administrator
Phone
(480) 969-0405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X OSC3651 AZ Primary

Addresses

Primary practice location

603 W Baseline Rd Ste 101
Mesa, AZ 85210-6050

Mailing address

603 W Baseline Rd Ste 101
Mesa, AZ 85210-6050
Phone (480) 969-0405

Other identifiers 1

IdentifierTypeStateIssuer
860929359OtherAZTRI WEST - TRICARE

Other names 1

  • Desert Endoscopy Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sdillon@desertendoscopy.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050421000128 AZ Part B Supplier - Ambulatory Surgical Center 8729982236 Practice locations: Mesa, AZ

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Mesa Az Endoscopy ASC LLCCCN 03C0001278
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1029540Mesa Az Endoscopy ASC, LLC, the603 West Baseline Road, Ste 101, Mesa, AZ 85210Certificate of waiverAug 17, 2026

National Provider Directory

National Provider Directory

Locations

603 W Baseline Rd
Mesa, AZ 85210

Interoperability endpoints

  • Direct secure messaging: sdillon@desertendoscopy.com

Practitioners & affiliated clinicians

Practitioners 156

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.

View all 156

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1770557233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 W BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106050",
            "telephone_number": "480-969-0405",
            "fax_number": "480-969-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 W BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106050",
            "telephone_number": "480-969-0405",
            "fax_number": "480-969-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA AZ ENDOSCOPY ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-13",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "DILLON",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "480-969-0405"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AZ",
            "license": "OSC3651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI WEST - TRICARE",
            "identifier": "860929359",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sdillon@desertendoscopy.com",
            "affiliation": "N",
            "endpointDescription": "Administrator encrypted email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "603 W Baseline Rd Ste 101",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852106050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Desert Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Desert Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.