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PRESCOTT MEDICAL AND DERMATOLOGY GROUP
NPI 1841929908
Dermatology in Prescott, AZ

Active since June 06, 2022CLIA 03D2296999 · Waiver
810 AINSWORTH DR, PRESCOTT, AZ 86301(928) 515-1155(928) 460-5158 Get Directions Write a Review

NPPES record last updated: November 10, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 10, 2025, Jun 6, 2022 (2 updates tracked since 2022).

About Prescott Medical And Dermatology Group NPPES

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

PRESCOTT MEDICAL AND DERMATOLOGY GROUP (NPI 1841929908) is a healthcare organization registered as a dermatology in Prescott, Arizona and active in the NPI registry since June 2022. The organization holds a CLIA Waiver certificate valid through January 8, 2028 and lists Burt I Faibisoff, Physician/owner, as its authorized official.

NPPES Registry Identity

NPI1841929908
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePRESCOTT MEDICAL AND DERMATOLOGY GROUP
Location Address810 AINSWORTH DRPrescott, AZ 86301-1612
Mailing Address810 Ainsworth DrPrescott, AZ 86301-1612 · (928) 515-1155 · Fax (928) 460-5158
Phone(928) 515-1155
Fax(928) 460-5158
Organization SubpartNo
Authorized OfficialBurt I FaibisoffPhysician/owner · (602) 476-4074
Enumeration DateJune 6, 2022
Last NPPES UpdateNovember 10, 20252 updates tracked since enumeration
NPPES CertifiedNovember 10, 2025
✔ NPI 1841929908 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedPlastic SurgeryTaxonomy 208200000X
810 AINSWORTH DR, Prescott, AZ 86301
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Prescott Medical And Dermatology Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Prescott Medical And Dermatology Group, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Burt Faibisoff, MD
Plastic and Reconstructive Surgery
NPI 1730128695
810 AINSWORTH DR
Prescott, AZ 86301
(928) 515-1155
✔ PECOS✔ Accepts MedicareSame address
Charles Johnson, M.D.
Dermatology
NPI 1336129667
830 AINSWORTH DRIVE
Prescott, AZ 86301
(928) 776-0325
✔ PECOS✔ Accepts MedicareSame address
Dean Stokes, MD
Family Practice
NPI 1639173370
830 AINSWORTH DR
Prescott, AZ 86301
(928) 776-0325
✔ PECOS✔ Accepts MedicareSame address

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 Waiver 03D2296999

Prescott Medical And Dermatology Group Operating Under Prescott Dermatology And Plastic Surgery · Prescott, AZ
Active · expires Jan 8, 2028
CLIA Number03D2296999
Laboratory TypePhysician Office
Certificate Effective DateJanuary 9, 2026
Certificate Expiration DateJanuary 8, 2028
Laboratory DirectorDean Stokes
Laboratory Phone(928) 515-1155
Laboratory LocationPrescott Medical And Dermatology Group Operating Under Prescott Dermatology And Plastic Surgery810 Ainsworth Dr, Prescott, AZ 86301
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Prescott Medical And Dermatology Group's NPI number?

The NPI number for Prescott Medical And Dermatology Group is 1841929908. It was assigned to this organization in the NPPES registry on June 6, 2022.

Where is Prescott Medical And Dermatology Group located?

Prescott Medical And Dermatology Group is located at 810 Ainsworth Dr, Prescott, AZ 86301. The listed phone number is (928) 515-1155.

What is Prescott Medical And Dermatology Group's specialty?

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

Is Prescott Medical And Dermatology Group enrolled in Medicare?

Yes. Prescott Medical And Dermatology Group is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Prescott Medical And Dermatology Group?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Prescott Medical And Dermatology Group, in Dermatology, Family Practice and Plastic and Reconstructive Surgery. 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. Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Prescott Medical And Dermatology Group hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2296999) is associated with this NPI, valid through January 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prescott Medical And Dermatology Group was last updated on November 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.