NPIMap

Individual provider Active NPI

Kyle Sanniec, MD

  • Plastic and Reconstructive Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1912340043
Registry record updated Jul 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
60973 Issued in AZ
Practice address
9250 N 3Rd St Ste 1003
Phoenix, AZ 85020-2402
Phone
(602) 331-7811
NPI assigned
Apr 8, 2013
Last updated
Jul 17, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Plastic and Reconstructive Surgery Physician 2086S0122X 60973 AZ Primary

Addresses

Primary practice location

9250 N 3Rd St Ste 1003
Phoenix, AZ 85020-2402

Mailing address

9250 N 3Rd St Ste 1003
Phoenix, AZ 85020-2402
Phone (602) 331-7811

Other practice location 1

5201 Harry Hines Blvd
Graduate Medical Education
Dallas, TX 75235-7708
Phone (214) 590-8058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200804001268 AZ Practitioner - Plastic and Reconstructive SurgeryPractitioner - Hand Surgery 9133544430 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive SurgeryAlso: Hand Surgery
Education
University of Arizona College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

8900 E Raintree Dr
Suite 200
Scottsdale, AZ 85260-7307
Phone (480) 752-7874

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy16
Melanoma (skin cancer) excision43
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Regenerative Institute PLLC Plastic and Reconstructive Surgery CurrentSince Aug 1, 2020 Accepting new patients
Valley Dermatology PLLC CurrentSince Mar 3, 2025 Accepting new patients
City of Hope Medical Group of Arizona LLC CurrentSince Mar 1, 2021 Accepting new patients
Valley Plastic Surgery PLLC CurrentSince Aug 1, 2023 Accepting new patients
Scottsdale Surgery Center One LLC Past Accepting new patients
Scottsdale Surgery Center Past Accepting new patients

Locations

5702 W Glendale Ave
Glendale, AZ 85301
Phone (623) 937-8969

14200 W Celebrate Life Way
Goodyear, AZ 85338
Phone (623) 207-3000

9250 N 3rd St
Ste 1003
Phoenix, AZ 85020
Phone (602) 331-7800

8900 E Raintree Dr
Ste 200
Scottsdale, AZ 85260
Phone (480) 752-7874

6897 Paysphere Cir
Chicago, IL 60674
Phone (480) 586-7542

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1912340043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 N 3RD ST STE 1003",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202402",
            "telephone_number": "602-331-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9250 N 3RD ST STE 1003",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202402",
            "telephone_number": "602-331-7811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5201 Harry Hines Blvd",
            "address_2": "Graduate Medical Education",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752357708",
            "country_code": "US",
            "telephone_number": "214-590-8058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANNIEC",
        "first_name": "KYLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-08",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "AZ",
            "license": "60973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.