Greenbrae Dermatology, a Medical Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G53455 Issued in CA

Legal business name

GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION

Practice address

1300 S Eliseo Dr Ste 207
Greenbrae, CA 94904-2015

Phone

(415) 925-0550

Fax

(415) 925-9062

NPI assigned

Mar 15, 2012

Last updated

Jun 30, 2015By 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

Mrs. Lucretia Ann Lewitt

Title

Practice Manager

Phone

(415) 925-0550

Specialties & licenses 12

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 9

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.

• Sally A Burtle, M.D.

  • Dermatology Physician
  • Richmond, CA
  • NPI 1821093972
  Medicare reassignment Care Compare group NPD
• Meghan Tara Hession, MD

  • Dermatology Physician
  • San Mateo, CA
  • NPI 1548546971
  Medicare reassignment Care Compare group NPD
• Sinae Angela Kane, MD

  • Dermatology Physician
  • San Francisco, CA
  • NPI 1003106014
  Medicare reassignment Care Compare group NPD
• Benjamin Joseph Nichols, MD

  • Dermatology Physician
  • Greenbrae, CA
  • NPI 1790983237
  Medicare reassignment Care Compare group NPD
• Clarence Chu, PA-C

  • Physician Assistant
  • San Francisco, CA
  • NPI 1891231924
  Medicare reassignment Care Compare group
• Madison Elizabeth Amos, PA-C

  • Surgical Physician Assistant
  • Norwalk, CT
  • NPI 1477067239

  CA

  Medicare reassignment Care Compare group
• Kambridge Pirc Hribar, MD

  • Otolaryngology Physician
  • Greenbrae, CA
  • NPI 1619100195
  Medicare reassignment NPD
• Francis Chuwei Hsiao, M.D., PHD.

  • Dermatology Physician
  • San Francisco, CA
  • NPI 1982855185
  Medicare reassignment NPD
• Cheryl Ann Tanasovich, M.D.

  • Procedural Dermatology Physician
  • Greenbrae, CA
  • NPI 1215960844
  Medicare reassignment NPD

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

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1174898654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S ELISEO DR STE 207",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042015",
            "telephone_number": "415-925-0550",
            "fax_number": "415-925-9062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S ELISEO DR STE 207",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042015",
            "telephone_number": "415-925-0550",
            "fax_number": "415-925-9062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-15",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "LEWITT",
        "authorized_official_first_name": "LUCRETIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "415-925-0550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G53455",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A97783",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G40606",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A97783",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "G53455",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "A97783",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "G53455",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "A97783",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "G40606",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G53455",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A97783",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G40606",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Flash Gordon, M.D.
• Jeremy Jayme Graham, RN, MSN, NP-C
• Tofani Grava, LMFT
• Andrea Gray, M.D.
• Greenbrae Care Center, LLC (Kindred Transitional Care and Rehabilitation-South Marin)
• Greenbrae Surgery Center
• Greenbrae Surgery Center
• Greenbrae Surgery Center LLC
• Ron Greene, PH.D
• Lisa-Sun Gresham

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; 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.