Prescott Medical and Dermatology Group

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PRESCOTT MEDICAL AND DERMATOLOGY GROUP

Practice address

810 Ainsworth Dr
Prescott, AZ 86301-1612

Phone

(928) 515-1155

Fax

(928) 460-5158

NPI assigned

Jun 6, 2022

Organization subpart

No

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

Authorized official

Name

Burt I Faibisoff, MDNPI 1730128695

Title

Physician/Owner

Phone

(602) 476-4074

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Burt I Faibisoff, MD

  • Plastic Surgery Physician
  • Prescott, AZ
  • NPI 1730128695
  Medicare reassignment Care Compare group NPD Authorized official
• Charles H Johnson, M.D.

  • Dermatology Physician
  • Prescott, AZ
  • NPI 1336129667
  Medicare reassignment Care Compare group NPD
• Dean H Stokes, MD

  • Dermatology Physician
  • Prescott, AZ
  • NPI 1639173370
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1841929908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 AINSWORTH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011612",
            "telephone_number": "928-515-1155",
            "fax_number": "928-460-5158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 AINSWORTH DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011612",
            "telephone_number": "928-515-1155",
            "fax_number": "928-460-5158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCOTT MEDICAL AND DERMATOLOGY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "FAIBISOFF",
        "authorized_official_first_name": "BURT",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "602-476-4074",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prescott Hearing LLC
• Prescott House Inc
• Prescott House Treatment LLC
• Prescott Interventional Radiology LLC
• Prescott Lung Physicians LTD
• Prescott Medical Executive Detox
• Prescott Medical Imaging, LLC
• Prescott Medical Investment LLC
• Prescott Mobililty Store Inc
• Prescott Nursing and Rehabilitation Center LLC

• Dermatology Physician in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; 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.