NPIMap

Organization Active NPI

Desert Sky Dermatology, PLLC

  • Dermatology Physician
  • Gilbert, AZ
National Provider Identifier
1871851691
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
45370 Issued in AZ
Legal business name
DESERT SKY DERMATOLOGY, PLLC
Practice address
1688 E. Boston St.
Suite #101
Gilbert, AZ 85295-6220
Phone
(480) 855-0085
Fax
(480) 855-0086
NPI assigned
Apr 30, 2012
Last updated
Mar 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Candice Berger
Title
Practice Manager
Phone
(480) 855-0085

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X 45370 AZ Primary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X 45370 AZ
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X 29461 AL

Addresses

Primary practice location

1688 E. Boston St.
Suite #101
Gilbert, AZ 85295-6220

Mailing address

1688 E. Boston St.
Suite #101
Gilbert, AZ 85295-6220
Phone (480) 855-0085

Other identifiers 1

IdentifierTypeStateIssuer
757618MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121025000803 AZ Part B Supplier - Clinic/Group Practice 3971753054 Receives reassigned benefits from 14 practitioners
Practice locations: Gilbert, AZ; Mesa, AZ

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
03D2163901Desert Sky Dermatology PLLC1688 E Boston Street Suite 101, Gilbert, AZ 85295ComplianceJun 28, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1688 E Boston St
Ste 121
Gilbert, AZ 85295

1688 E Boston St
Ste 102
Gilbert, AZ 85295

1688 E Boston St
Ste 121124
Gilbert, AZ 85295
Phone (480) 855-0085

1688 E Boston St
Ste 101
Gilbert, AZ 85295
Phone (480) 855-0085

1688 E Boston St
Gilbert, AZ 85295
Phone (480) 855-0085

7205 E Baseline Rd
Mesa, AZ 85209
Phone (480) 855-0085

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1871851691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1688 E. BOSTON ST.",
            "address_2": "SUITE #101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852956220",
            "telephone_number": "480-855-0085",
            "fax_number": "480-855-0086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1688 E. BOSTON ST.",
            "address_2": "SUITE #101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852956220",
            "telephone_number": "480-855-0085",
            "fax_number": "480-855-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT SKY DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-30",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "BERGER",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "480-855-0085"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "45370",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "AZ",
            "license": "45370",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AL",
            "license": "29461",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "757618",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.