Medderm Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A88009 Issued in CA

Legal business name

MEDDERM CORPORATION

Doing business as

Medderm Associates

Practice address

3965 5TH Ave Ste 200
San Diego, CA 92103-3107

Phone

(619) 542-0013

Fax

(619) 542-0559

NPI assigned

Jul 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michelle Terez Pelle, M.D.NPI 1043252786

Title

Owner/Director

Phone

(619) 542-0013

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medderm Associates Doing business as

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

Locations

Practitioners 8

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

• Michelle Terez Pelle, M.D.

  • Dermatology Physician
  • San Diego, CA
  • NPI 1043252786
  Medicare reassignment Care Compare group NPD Authorized official
• Patrick W Blake, MD

  • Dermatology Physician
  • San Diego, CA
  • NPI 1871817312
  Medicare reassignment Care Compare group NPD
• Jay L Blake, NP

  • Nurse Practitioner
  • Eugene, OR
  • NPI 1619284742

  CA

  Medicare reassignment Care Compare group NPD
• Sarah Ann Moore, MD

  • Student in an Organized Health Care Education/Training Program
  • Spokane, WA
  • NPI 1265994891

  CA

  Medicare reassignment Care Compare group NPD
• Ashley Jean Calanni

  • Physician Assistant
  • San Diego, CA
  • NPI 1164950184
  Medicare reassignment Care Compare group
• Michael Lee, M.D.

  • Dermatology Physician
  • San Diego, CA
  • NPI 1255607685
  Medicare reassignment Care Compare group
• Judy Chen Doong, MD

  • MOHS-Micrographic Surgery Physician
  • Reno, NV
  • NPI 1215326236

  CA, Dermatology

  Medicare reassignment NPD
• Azadeh R Shirazi, MD

  • Dermatology Physician
  • La Jolla, CA
  • NPI 1679557144
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1063447936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 5TH AVE STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033107",
            "telephone_number": "619-542-0013",
            "fax_number": "619-542-0559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3965 5TH AVE STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033107",
            "telephone_number": "619-542-0013",
            "fax_number": "619-542-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDDERM CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "PELLE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "TEREZ",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "619-542-0013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A88009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A880090",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medderm Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; 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.