Golden Coast Dermatology, Skin Cancer and Vein Center PC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

GOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC

Practice address

26732 Crown Valley Pkwy Ste 571
Mission Viejo, CA 92691-7305

Phone

(270) 933-2109

NPI assigned

Nov 20, 2019

Organization subpart

No

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

Authorized official

Name

William Tidwell, MD

Title

Owner/Physician

Phone

(270) 933-2109

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00141

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Y Kim, D.O.

  • Dermatology Physician
  • Mission Viejo, CA
  • NPI 1245663228
  Medicare reassignment NPD

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585267200000",
    "number": "1053957456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26732 CROWN VALLEY PKWY STE 571",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917305",
            "telephone_number": "270-933-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26732 CROWN VALLEY PKWY STE 571",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917305",
            "telephone_number": "270-933-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN COAST DERMATOLOGY, SKIN CANCER AND VEIN CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "270-933-2109",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA STATE LICENSE",
            "identifier": "A147575",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra F Globus, CFNP
• Gloriosa Management LLC
• Bailey Godber
• Anna Isabel Godinez
• Robert Y. Goldberg, MD
• Lindsay Joy Golden, LMFT
• Jennifer W Gong, O.D.
• Geoffrey Gonick, MD
• Claudia Judith Gonzalez de Griese, B.S., M.S
• Nancy Yareth Gonzalez-McKenzie, LCSW

• MOHS-Micrographic Surgery Physician in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• MOHS-Micrographic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.