Advanced Dermatology of Arizona, PC
Organization Active NPI Dermatology Physician · Scottsdale, AZ
NPI 1922484088 · NPPES record last updated Jul 30, 2015
Key facts
- NPI
- 1922484088
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- ADVANCED DERMATOLOGY OF ARIZONA, PC
- Practice address
- 8817 E Bell Rd Ste 101
Scottsdale, AZ 85260-1589 - Phone
- (602) 264-9044
- NPI assigned
- Jul 30, 2015
- Organization subpart
- No
Authorized official
- Name
- Linda Crandall
- Title
- Credentialing Coordinator
- Phone
- (970) 484-6303
Practitioners 27
-
Yi Gao, MD
-
Bill Hale Halmi, MD
-
Cassandra Lynn Henderson, PA-C
-
Yulia Khan, MD
-
Matthew Snyder Laffer, D.O.
-
Jason W Arnett, P.A.
-
Michelle Davis, PA
-
Andrew G Hicks, PA
-
Kendall D Jenson, PA- C
-
Tasha S Mack, PA-C
-
Sean Lloyd, PA-C
-
Glenn K Yarbrough, M.D.
-
Dylan Irish, PA-C
-
Molly Moloznik, P.A.-C
-
Kara Sue Gooding, PA C
-
Michelle L Jeffries, D.O.
-
Arundathi P. Narayanappa, P.A.
-
Elizabeth Ann Penfold, PHYSICIAN ASSISTANT
-
Jessica Lauren Rosenblum, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2132603 | Advanced Dermatology of Arizona | Compliance | Oct 20, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151223000796 | AZ | Part B Supplier - Clinic/Group Practice | 0547561169 |
Receives reassigned benefits from 19 practitioners Practice locations: Scottsdale, AZ; Gilbert, AZ; Phoenix, AZ; Avondale, AZ |
National Provider Directory
Locations
10825 W McDowell Rd
Ste 300
Avondale, AZ 85392
Phone (602) 767-1959
10825 W McDowell Rd
Avondale, AZ 85392
3509 S Mercy Rd
Ste 103
Gilbert, AZ 85297
Phone (602) 264-9044
740 E Highland Ave
Ste 101
Phoenix, AZ 85014
Phone (602) 264-9044
740 E Highland Ave
Ste 203
Phoenix, AZ 85014
Phone (602) 264-9044
740 E Highland Ave
Phoenix, AZ 85014
Phone (602) 264-9044
3302 N Miller Rd
Ste D
Scottsdale, AZ 85251
Phone (480) 945-6356
8817 E Bell Rd
Ste 101
Scottsdale, AZ 85260
Phone (480) 513-9440
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
8817 E Bell Rd Ste 101
Scottsdale, AZ 85260-1589
Mailing address
151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (407) 875-2080
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All providers in Scottsdale, AZ · Dermatology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.