North Bay Dermatology Associates

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

NORTH BAY DERMATOLOGY ASSOCIATES

Doing business as

North Bay Dermatology

Practice address

106 Lynch Creek Way
Suite #8
Petaluma, CA 94954-2356

Phone

(707) 763-6816

Fax

(707) 763-1730

NPI assigned

Oct 12, 2006

Organization subpart

No

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

Authorized official

Name

Santiago Centurion, M.D.NPI 1710099585

Title

Practice Owner

Phone

(707) 763-6816

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• North Bay Dermatology Doing business as
• Glenn A. Koby, MD Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 3

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.

• Santiago Alberto Centurion, M.D.

  • Dermatology Physician
  • Old Bridge, NJ
  • NPI 1710099585

  CA

  Medicare reassignment Care Compare group Authorized official
• Erin Hanauer, PA-C

  • Medical Physician Assistant
  • Petaluma, CA
  • NPI 1851490718
  Medicare reassignment Care Compare group
• Cristina S Centurion, NP-C

  • Family Nurse Practitioner
  • Old Bridge, NJ
  • NPI 1710053095

  CA

  Medicare reassignment

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1275622664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 LYNCH CREEK WAY",
            "address_2": "SUITE #8",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542356",
            "telephone_number": "707-763-6816",
            "fax_number": "707-763-1730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 LYNCH CREEK WAY",
            "address_2": "SUITE #8",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542356",
            "telephone_number": "707-763-6816",
            "fax_number": "707-763-1730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BAY DERMATOLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "CENTURION",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "707-763-6816",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILTOAD MEDICARE",
            "identifier": "J5792",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Bay Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Glenn A. Koby, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nudrat Raza Noorani
• Norcal Healthconnect LLC (Petaluma Valley Hospital)
• Norcal Medical Supply, Inc
• North Bay Dermatology & Skin Cancer Center P C
• North Bay Dermatology Assoc
• North Bay Electrology
• North Bay Endoscopy Center LLC (the endosurgery center)
• North Bay Eye Associates, a Medical Corporation (North Bay Eye Associates, Inc)
• North Bay Foot & Ankle Center Inc
• North Bay Post Acute, LLC (North Bay Post Acute)

• Specialist in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.