NPIMap

Organization Active NPI

Surgicalist of Az PLLC

  • Trauma Surgery Physician
  • Goodyear, AZ
National Provider Identifier
1881196335
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Trauma Surgery PhysicianTaxonomy code 2086S0127X
Legal business name
SURGICALIST OF AZ PLLC
Practice address
13555 W McDowell Rd Ste 204
Goodyear, AZ 85395-2626
Phone
(623) 512-4326
NPI assigned
Mar 1, 2018
Last updated
Sep 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
THE SURGICALIST GROUP PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

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

Authorized official

Name
Mit Desai, MDNPI 1407822422
Title
Ceo
Phone
(813) 530-5043

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU
Trauma Surgery Physician 2086S0127X NU Primary
Vascular Surgery Physician 2086S0129X NU

Addresses

Primary practice location

13555 W McDowell Rd Ste 204
Goodyear, AZ 85395-2626

Mailing address

PO Box 21647
Tampa, FL 33622-1647
Phone (813) 530-5043

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180514002788 AZ Part B Supplier - Clinic/Group Practice 2264796531 Receives reassigned benefits from 10 practitioners
Practice locations: Goodyear, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1881196335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21647",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336221647",
            "telephone_number": "813-530-5043",
            "fax_number": "813-530-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13555 W MCDOWELL RD STE 204",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952626",
            "telephone_number": "623-512-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICALIST OF AZ PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE SURGICALIST GROUP PLLC",
        "enumeration_date": "2018-03-01",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "DESAI",
        "authorized_official_first_name": "MIT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-530-5043",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.

Verify at the official NPI Registry.