Derek Walter Nickerson, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

A171167 Issued in CA

Practice address

5550 Carmel Mountain Rd
San Diego, CA 92130-4853

Phone

(858) 943-2540

NPI assigned

Apr 2, 2016

Last updated

May 18, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

New York Medical College, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grossmont Dermatology Medical ClinicGroup PAC ID 4981672342, 10 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

20.76 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

69.19

Merit-based Incentive Payment System (MIPS)

Final score

85.34 of 100Reported as group

Quality

90.85

Promoting interoperability

87

Improvement activities

40

Cost

71.11

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grossmont Dermatology Medical Clinic

  dba Coastal Skin and Eye Institute

  • Procedural Dermatology Physician
  • La Mesa, CA
  • NPI 1194838441
  Medicare reassignment Care Compare group NPD
• Coastal Skin and Eye Institute, Inc.

  • Dermatology Physician
  • San Diego, CA
  • NPI 1790232015
  Medicare reassignment NPD
• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804

  Dermatology

  Medicare reassignment NPD
• Carlsbad and Vista Dermatology, Inc.

  • Dermatology Physician
  • Vista, CA
  • NPI 1124328505
  NPD
• Stephen William Doggett, M.D. PA

  • Radiation Oncology Physician
  • Newport Beach, CA
  • NPI 1427281666
  NPD

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

{
    "created_epoch": "1459555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747526400000",
    "number": "1265895619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5550 CARMEL MOUNTAIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921304853",
            "telephone_number": "858-943-2540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5550 CARMEL MOUNTAIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921304853",
            "telephone_number": "858-943-2540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "DEREK",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-02",
        "last_updated": "2025-05-18",
        "certification_date": "2025-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A171167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy R Nickel, MPT
• Amber Nickell, ACSW
• Victoria Nickell
• Paige Morgan Nickelsen, PHARMD
• Emaree Nickerson-Wright
• Heather Nickerson, MA, RBT
• Wendy Diane Nickerson, LCSW
• Aikkiko Nickler, IDC
• Carol Cristman Nickless, RN, PHN, BSN
• Brenda Nickolaison, LCSW

• MOHS-Micrographic Surgery Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• MOHS-Micrographic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.