Active NPI
Roy Jay Watts, DO
- Internal Medicine Physician
- Surprise, AZ
National Provider Identifier
1770699308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 2156
- Practice address
- 13921 W Grand Ave
Suite 502
Surprise, AZ 85374-2439 - Phone
- (623) 214-2200
- Fax
- (623) 214-2208
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 2156 | AZ | Primary |
Addresses
Primary practice location
13921 W Grand Ave
Suite 502
Surprise, AZ 85374-2439
Mailing address
13921 W Grand Ave
Suite 502
Surprise, AZ 85374-2439
Phone (623) 214-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161977 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2156 | AR | MD | Registered Dietitian |
| 2156 | AZ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443744000000",
"number": "1770699308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13921 W GRAND AVE",
"address_2": "SUITE 502",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853742439",
"telephone_number": "623-214-2200",
"fax_number": "623-214-2208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13921 W GRAND AVE",
"address_2": "SUITE 502",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853742439",
"telephone_number": "623-214-2200",
"fax_number": "623-214-2208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTS",
"first_name": "ROY",
"middle_name": "JAY",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2015-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AZ",
"license": "2156",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "161977",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.