NPIMap

Organization Active NPI

Regency Skin Institute PLLC

  • MOHS-Micrographic Surgery Physician
  • Surprise, AZ
National Provider Identifier
1932630563
Registry record updated Oct 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
49090 Issued in AZ
Legal business name
REGENCY SKIN INSTITUTE PLLC
Practice address
14725 W Mountain View Blvd
Surprise, AZ 85374-2704
Phone
(623) 243-9077
NPI assigned
Mar 24, 2017
Last updated
Oct 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2026

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

Authorized official

Name
Jason Lee Mussman, M.D.NPI 1144430182
Title
Plastic Surgeon
Phone
(989) 255-4794

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X 49090 AZ Primary

Addresses

Primary practice location

14725 W Mountain View Blvd
Surprise, AZ 85374-2704

Mailing address

10240 W Indian School Rd
Suite 115
Phoenix, AZ 85037-5904

Other practice location 1

10240 W Indian School Rd
Suite 115
Phoenix, AZ 85037-5904
Phone (623) 243-9077

Other practice location 2

2640 N Verrado Way
Buckeye, AZ 85396
Phone (623) 243-9077

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170817002453 AZ Part B Supplier - Clinic/Group Practice 5193097665 Receives reassigned benefits from 29 practitioners
Practice locations: Phoenix, AZ; Surprise, AZ

National Provider Directory

National Provider Directory

Locations

10240 W Indian School Rd
Ste 105
Phoenix, AZ 85037

1540 Maple Rd
Fl 2
Williamsville, NY 14221

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791504000000",
    "number": "1932630563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10240 W INDIAN SCHOOL RD",
            "address_2": "SUITE 115",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14725 W MOUNTAIN VIEW BLVD",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853742704",
            "telephone_number": "623-243-9077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10240 W Indian School Rd",
            "address_2": "Suite 115",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850375904",
            "country_code": "US",
            "telephone_number": "623-243-9077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2640 N Verrado Way",
            "address_purpose": "LOCATION",
            "city": "Buckeye",
            "state": "AZ",
            "postal_code": "85396",
            "country_code": "US",
            "telephone_number": "623-243-9077",
            "fax_number": "623-271-9826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REGENCY SKIN INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-24",
        "last_updated": "2026-10-09",
        "certification_date": "2026-10-09",
        "status": "A",
        "authorized_official_last_name": "MUSSMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PLASTIC SURGEON",
        "authorized_official_telephone_number": "989-255-4794",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "49090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2026; 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.