NPIMap

Organization Active NPI

Az Dermatology

  • Specialist
  • Maricopa, AZ
National Provider Identifier
1962737965
Registry record updated Oct 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
36353 Issued in AZ
Legal business name
AZ DERMATOLOGY
Practice address
21300 N John Wayne Pkwy
Suite 112
Maricopa, AZ 85139-8979
Phone
(520) 374-2462
Fax
(520) 374-2467
NPI assigned
Oct 8, 2009
Last updated
Oct 8, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2009

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

Authorized official

Name
Dr. Jayshri Gamoth, M.D.NPI 1851340467
Title
Owner
Phone
(520) 374-2462

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 36353 AZ Primary

Addresses

Primary practice location

21300 N John Wayne Pkwy
Suite 112
Maricopa, AZ 85139-8979

Mailing address

1821 N Trekell Rd
Suite 5
Casa Grande, AZ 85122-1705
Phone (520) 374-2462

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080317000520 AZ Part B Supplier - Clinic/Group Practice 5698850543 Receives reassigned benefits from 29 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Casa Grande, AZ; Sun City, AZ; Mesa, AZ; Gold Canyon, AZ; Chandler, AZ

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1343 N Alma School Rd
Ste 135
Chandler, AZ 85224
Phone (480) 444-7472

959 N McQueen Rd
Chandler, AZ 85225
Phone (480) 982-3337

1025 W 24th St
Ste 5
Yuma, AZ 85364
Phone (520) 374-2462

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254960000000",
    "number": "1962737965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 N TREKELL RD",
            "address_2": "SUITE 5",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851221705",
            "telephone_number": "520-374-2462",
            "fax_number": "520-374-2467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 N JOHN WAYNE PKWY",
            "address_2": "SUITE 112",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851398979",
            "telephone_number": "520-374-2462",
            "fax_number": "520-374-2467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2009-10-08",
        "status": "A",
        "authorized_official_last_name": "GAMOTH",
        "authorized_official_first_name": "JAYSHRI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-374-2462",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "36353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maricopa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2009; 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.