1. Home
  2. Directory
  3. Arizona
  4. Phoenix
  5. Dermatology
  6. NPI Profile

PHOENIX SKIN MEDICAL SURGICAL GROUP
NPI 1609078997
Dermatology in Phoenix, AZ

Active since May 31, 2007CLIA 03D2001285 · Certificate of Compliance
5056 N CENTRAL AVE, PHOENIX, AZ 85012(602) 222-9111(602) 277-5111 Get Directions Write a Review

NPPES record last updated: December 12, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Phoenix Skin Medical Surgical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHOENIX SKIN MEDICAL SURGICAL GROUP (NPI 1609078997) is a healthcare organization registered as a dermatology in Phoenix, Arizona and active in the NPI registry since May 2007. The organization holds a CLIA Certificate of Compliance certificate valid through March 8, 2027 and lists Lee P Laris, Physician, as its authorized official.

NPPES Registry Identity

NPI1609078997
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePHOENIX SKIN II PC
Location Address5056 N CENTRAL AVEPhoenix, AZ 85012-1521
Mailing Address5056 N Central AvePhoenix, AZ 85012-1521 · (602) 222-9111 · Fax (602) 277-5111
Phone(602) 222-9111
Fax(602) 277-5111
Organization SubpartNo
Authorized OfficialLee P LarisPhysician · (602) 222-9111
Enumeration DateMay 31, 2007
Last NPPES UpdateDecember 12, 2023
NPPES CertifiedDecember 12, 2023
✔ NPI 1609078997 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
5056 N CENTRAL AVE, Phoenix, AZ 85012
Open in Google Maps ↗

Other Names 1

Doing Business AsPhoenix Skin Medical Surgical Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Phoenix Skin Medical Surgical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Phoenix Skin Medical Surgical Group, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Lee Laris, DO
Dermatology
NPI 1649274671
5056 N CENTRAL AVE
Phoenix, AZ 85012
(602) 222-9111
✔ PECOS✔ Accepts MedicareSame address
Emily Sandahl, FNP-C
Nurse Practitioner
NPI 1548146756
5056 N CENTRAL AVE
Phoenix, AZ 85012
(602) 222-9111
✔ PECOS✔ Accepts MedicareSame address
Ramona Kiani, DNP, FNP
Nurse Practitioner
NPI 1861843765
5056 N CENTRAL AVE
Phoenix, AZ 85012
(602) 222-9111
✔ PECOS✔ Accepts MedicareSame address
Nichelle Madden, D.O.
Dermatology
NPI 1952793408
5056 N CENTRAL AVE
Phoenix, AZ 85012
(602) 222-9111
✔ PECOS✔ Accepts MedicareSame address
Megan Ahmed, FNP
Nurse Practitioner
NPI 1134678634
7301 E 2ND ST STE 310
Scottsdale, AZ 85251
(480) 618-5976
✔ PECOS✔ Accepts Medicare8.8 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 03D2001285

Phoenix Skin Medical Surgical Group · Phoenix, AZ
Active · expires Mar 8, 2027
CLIA Number03D2001285
Laboratory TypePhysician Office
Certificate Effective DateMarch 9, 2025
Certificate Expiration DateMarch 8, 2027
Laboratory DirectorNichelle K. Madden
Laboratory Phone(602) 222-9111
Laboratory LocationPhoenix Skin Medical Surgical Group5056 N Central Avenue, Phoenix, AZ 85012
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phoenix Skin II PC's NPI number?

The NPI number for Phoenix Skin II PC is 1609078997. It was assigned to this organization in the NPPES registry on May 31, 2007. The provider is doing business as Phoenix Skin Medical Surgical Group.

Where is Phoenix Skin II PC located?

Phoenix Skin II PC is located at 5056 N Central Ave, Phoenix, AZ 85012. The listed phone number is (602) 222-9111.

What is Phoenix Skin II PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Phoenix Skin II PC enrolled in Medicare?

Yes. Phoenix Skin II PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Phoenix Skin II PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Phoenix Skin II PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (3) and Dermatology (2). Of these, 4 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Phoenix Skin II PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 03D2001285) is associated with this NPI, valid through March 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Phoenix Skin II PC accept?

Health plans from Ambetter Health and Ambetter from Arizona Complete Health list Phoenix Skin II PC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Phoenix Skin II PC was last updated on December 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.