Green Dermatologic Medical Group a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

C36384 Issued in CA

Legal business name

GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION

Practice address

657 Camino de Los Mares Ste 242
San Clemente, CA 92673-2811

Phone

(949) 496-6066

Fax

(949) 496-6497

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Roger E Green, M. D.NPI 1215917968

Title

Medical Doctor

Phone

(949) 496-6066

Specialties & licenses 1

Addresses

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 3

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

• Roger Elliott Green, MD

  • Dermatology Physician
  • San Clemente, CA
  • NPI 1215917968
  NPD Authorized official
• Rollin M Green, MD

  • Dermatology Physician
  • Laguna Hills, CA
  • NPI 1245206705
  NPD
• Thomas E Ahlering, M.D.

  • Urology Physician
  • Orange, CA
  • NPI 1013983386
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1154533685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 CAMINO DE LOS MARES STE 242",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732811",
            "telephone_number": "949-496-6066",
            "fax_number": "949-496-6497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 CAMINO DE LOS MARES STE 242",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732811",
            "telephone_number": "949-496-6066",
            "fax_number": "949-496-6497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "949-496-6066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "C36384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marilyn Gottdank, MFT
• Maritza Granados, ACSW, PPSC
• Gratias, Inc.
• Greathouse Chiropractic Inc
• Wayne Greathouse, DC
• Roger Elliott Green, MD
• Matthew Alan Greene
• Suzanne Greene
• Nicola Greenhalgh
• Tahjaniera A Greenwade, LVN

• Specialist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.