Organization Active NPI

On Site Dermatology of California PC

  • Dermatology Physician
  • San Diego, CA
National Provider Identifier
1154842771
Registry record updated Feb 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ON SITE DERMATOLOGY OF CALIFORNIA PC
Practice address
13075 Evening Creek Dr S
San Diego, CA 92128-8101
Phone
(877) 345-5300
Fax
(561) 989-3665
NPI assigned
Jul 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2019

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

Authorized official

Name
Adam Plotkin, MD
Title
Authorized Official
Phone
(561) 314-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

13075 Evening Creek Dr S
San Diego, CA 92128-8101

Mailing address

4700 Exchange CT Ste 110
Boca Raton, FL 33431-4450
Phone (561) 314-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171010003034 CA Part B Supplier - Clinic/Group Practice 8426323858 Receives reassigned benefits from 5 practitioners
Practice locations: Los Angeles, CA; National City, CA; Northridge, CA; Placerville, CA; Playa Vista, CA; Rocklin, CA; Roseville, CA; Sacramento, CA…

National Provider Directory

National Provider Directory

Locations

3388 Bell Rd
Auburn, CA 95603
Phone (530) 889-8122

8550 Barton Rd
Granite Bay, CA 95746

849 Coast Blvd
La Jolla, CA 92037
Phone (858) 252-2700

960 N Martel Ave
Los Angeles, CA 90046
Phone (323) 251-1426

345 Munroe St
Sacramento, CA 95825

4518 54th St
San Diego, CA 92115
Phone (619) 287-2920

2360 Albatross St
San Diego, CA 92101
Phone (619) 233-8382

18655 W Bernardo Dr
San Diego, CA 92127
Phone (858) 451-9152

1312 15th St
Santa Monica, CA 90404
Phone (310) 393-2260

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548979200000",
    "number": "1154842771",
    "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": "13075 EVENING CREEK DR S",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921288101",
            "telephone_number": "877-345-5300",
            "fax_number": "561-989-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ON SITE DERMATOLOGY OF CALIFORNIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-05",
        "last_updated": "2019-02-01",
        "status": "A",
        "authorized_official_last_name": "PLOTKIN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "561-314-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; 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.