Eitan Homa MD and Jennifer Krasnoff MD Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

EITAN HOMA MD AND JENNIFER KRASNOFF MD INC

Doing business as

Dermatology Associates of the Bay Area

Practice address

500 Alfred Nobel Dr
Ste 245
Hercules, CA 94547

Phone

(510) 741-7418

Fax

(510) 741-7456

NPI assigned

Sep 29, 2006

Last updated

May 6, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Marlene Kole

Title

Office Manager

Phone

(510) 741-7418

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dermatology Associates of the Bay Area 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

Tax ID family

Dermatology Associates of the2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Eitan Homa and Jennifer Krasnoff MD Inc

  • Dermatology Physician
  • Petaluma, CA
  • NPI 1891821427
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carla Anna Fisher, M.D.

  • Dermatology Physician
  • Petaluma, CA
  • NPI 1215934096
  Medicare reassignment Care Compare group NPD
• Whitney Fisk

  • Dermatology Physician
  • Sacramento, CA
  • NPI 1306194584
  Medicare reassignment Care Compare group NPD
• Eitan Homa, M.D.

  • Specialist
  • Petaluma, CA
  • NPI 1326120718
  Medicare reassignment Care Compare group NPD
• Jennifer Krasnoff, MD

  • Specialist
  • Hercules, CA
  • NPI 1548342934
  Medicare reassignment Care Compare group NPD
• Jonathan Okman, M.D.

  • Dermatology Physician
  • Hercules, CA
  • NPI 1003227372
  Medicare reassignment Care Compare group NPD
• Wendy B. Mazursky, PA-C, MS

  • Physician Assistant
  • Hercules, CA
  • NPI 1255425583
  NPD (past)

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1164514881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ALFRED NOBEL DR",
            "address_2": "STE 245",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "94547",
            "telephone_number": "510-741-7418",
            "fax_number": "510-741-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ALFRED NOBEL DR",
            "address_2": "STE 245",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "94547",
            "telephone_number": "510-741-7418",
            "fax_number": "510-741-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EITAN HOMA MD AND JENNIFER KRASNOFF MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "KOLE",
        "authorized_official_first_name": "MARLENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "510-741-7418",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "C14303",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHILED",
            "identifier": "ZZZ00647Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Associates of the Bay Area",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fran M Didomenicis, PH.D.
• Heather Isabel Divine
• Amrit Dosanjh
• Douglas Lin, DDS, Inc (Hercules Dental Care)
• Dung Optometric Group
• Emerald Caregiving, LLC
• McWayne Maskarino Enad
• Encompass Consulting, LLC
• Gary Eng
• Geraldine Enriquez-Louie, RRT

• Dermatology Physician in Hercules, CA
• Providers in Hercules, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; 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.