Active NPI
Keri Rae Desoto, MD
- Internal Medicine Physician
- Prescott, AZ
National Provider Identifier
1982626594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 31505
- Practice address
- 1058 Fair St
Suite B
Prescott, AZ 86305 - Phone
- (928) 443-7777
- Fax
- (888) 972-8306
- NPI assigned
- Jul 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 31505 | AZ | Primary |
Addresses
Primary practice location
1058 Fair St
Suite B
Prescott, AZ 86305
Mailing address
1058 Fair St S
Suite B
Prescott, AZ 86305
Phone (928) 443-7777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2014 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31505 | AZ | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455235200000",
"number": "1982626594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1058 FAIR ST S",
"address_2": "SUITE B",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "86305",
"telephone_number": "928-443-7777",
"fax_number": "888-972-8306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1058 FAIR ST",
"address_2": "SUITE B",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "86305",
"telephone_number": "928-443-7777",
"fax_number": "888-972-8306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESOTO",
"first_name": "KERI",
"middle_name": "RAE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2016-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AZ",
"license": "31505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.