Integrated Dermatology of Lincoln, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTEGRATED DERMATOLOGY OF LINCOLN, PC

Practice address

2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356

Phone

(530) 527-0414

NPI assigned

Dec 10, 2021

Organization subpart

No

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

Authorized official

Name

Jennifer T Haley, MD

Title

Authorized Group Official

Phone

(561) 314-2000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

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

• Derrick H Adams, D.O.

  • Dermatology Physician
  • Lincoln, CA
  • NPI 1659352219
  Medicare reassignment Care Compare group NPD
• Ramneet Basra, PA-C

  • Medical Physician Assistant
  • Lincoln, CA
  • NPI 1457874893
  Medicare reassignment Care Compare group
• Caitlin O'Malley, PA

  • Physician Assistant
  • Rocklin, CA
  • NPI 1265100853
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1639094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639094400000",
    "number": "1104585884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-314-2000",
            "fax_number": "561-431-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 SISTER MARY COLUMBA DR",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960804356",
            "telephone_number": "530-527-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED DERMATOLOGY OF LINCOLN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-10",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "HALEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "AUTHORIZED GROUP OFFICIAL",
        "authorized_official_telephone_number": "561-314-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Darryl Hutton, LMFT
• Kaare Andrew Hyde, CRS
• Madeline R. Hyde, MS, LMFT 162834
• Julia Ichikawa, DDS
• Veronica Im, MSW, ASW
• Interim Assisted Care of Northern California (Interim HealthCare Personal Care & Support Serives)
• Interim Assisted Care of Northern California, Inc. (Interim HomeStyle Services)
• Kelli Anne Irving
• Michelle Ison
• Megan Jackson

• Dermatology Physician in Red Bluff, CA
• Providers in Red Bluff, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.