PALM CANYON DERMATOLOGY, PC (NPI# 1437339470) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437339470 |
| Entity Type | Organization |
| Organization Name | PALM CANYON DERMATOLOGY, PC |
| Practice Address |
350 W Catalina Dr Yuma AZ 85364-8112 |
| Practice Telephone | 9283440650 |
| Practice Fax Number | 9283443928 |
| Mailing Telephone | 9283440650 |
| Mailing Fax Number | 9283443928 |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2007-11-16 |
| Authorized Official Name | MR. GREGORY ANDREW ERTL (PRESIDENT/OWNER) |
| Authorized Official Telephone | 9283440650 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | 19732 | AZ | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAIL ROAD MEDICARE | CG5646 | 01 |
| Street Address |
350 W CATALINA DR |
| City | YUMA |
| State | AZ |
| Zip Code | 85364-8112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427051184 | Gregory A Ertl | Specialist | 350 W Catalina Dr, Yuma, AZ 85364-8112 | 2005-05-24 |
| 1871585943 | Sandra M Corbin | Physician Assistant | 350 W Catalina Dr, Yuma, AZ 85364-8112 | 2005-08-16 |
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|---|---|---|---|---|
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| 1417573742 | Shanti Auto Injury and Accident, Pllc | Clinic/Center | 1695 W 24h St, Suite C, Yuma, AZ 85364 | 2020-06-23 |
| 1144846999 | Surur Nader Sharif | Student in an Organized Health Care Education/Training Program | Yuma Regional Medical Center 2400 Avenue A, Yuma, AZ 85364 | 2020-06-17 |
| 1710533211 | Erika White | Specialist/Technologist | 3150 S Ave A, Yuma, AZ 85364 | 2019-08-12 |
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| 1801375597 | Rebecca L Conover | Occupational Therapy Assistant | Yuma Elementary School District One, 450 S. 6th Street, Yuma, AZ 85364 | 2018-08-13 |
| 1861984791 | Thomas Francisco Burrell | Pharmacist | 1150 W 8th Street, Yuma, AZ 85364 | 2018-06-06 |
| 1356833834 | Elizabeth Schlenner | Nurse Practitioner | 2637 S 34th Ave, Yuma, AZ 85364 | 2018-05-31 |
| Find all providers in zip 85364 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
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|---|---|---|---|---|
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.