Active NPI
Az Dermatology, LLC
- Specialist
- Yuma, AZ
National Provider Identifier
1770818130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 36353
- Legal business name
- AZ DERMATOLOGY, LLC
- Practice address
- 1025 W 24TH St
Suite 5
Yuma, AZ 85364-8366 - Phone
- (520) 374-2462
- Fax
- (520) 374-2467
- NPI assigned
- Oct 2, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jayshri Gamoth, M.D.
- Title
- Owner
- Phone
- (520) 374-2462
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 36353 | AZ | Primary |
Addresses
Primary practice location
1025 W 24TH St
Suite 5
Yuma, AZ 85364-8366
Mailing address
1821 N Trekell Rd
Suite 5
Casa Grande, AZ 85122-1705
Phone (520) 374-2462
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080317000520 | AZ | Part B Supplier - Clinic/Group Practice | 5698850543 |
Receives reassigned benefits from 29 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Casa Grande, AZ; Sun City, AZ; Mesa, AZ; Gold Canyon, AZ; Chandler, AZ |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254441600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1512604800000",
"number": "1770818130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1821 N TREKELL RD",
"address_2": "SUITE 5",
"city": "CASA GRANDE",
"state": "AZ",
"postal_code": "851221705",
"telephone_number": "520-374-2462",
"fax_number": "520-374-2467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 W 24TH ST",
"address_2": "SUITE 5",
"city": "YUMA",
"state": "AZ",
"postal_code": "853648366",
"telephone_number": "520-374-2462",
"fax_number": "520-374-2467"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AZ DERMATOLOGY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-10-02",
"last_updated": "2017-12-07",
"status": "A",
"authorized_official_last_name": "GAMOTH",
"authorized_official_first_name": "JAYSHRI",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "520-374-2462",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "AZ",
"license": "36353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; 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.