Fredric Robert Rosenberg, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G21402 Issued in CA

Practice address

3650 E. South Street
#306
Lakewood, CA 90712

Phone

(310) 378-1915

Fax

(310) 378-6979

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 4

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

Dermatology

Education

Albert Einstein College of Medicine of Yeshiva University, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology Surgical and Medical Group IncGroup PAC ID 5294779898, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

• Advanced Dermatology Surgical and Medical Group Inc.

  • Dermatology Physician
  • Lakewood, CA
  • NPI 1154407856
  Medicare reassignment Care Compare group NPD Authorized official
• Dignity Health

  • General Acute Care Hospital
  • Long Beach, CA
  • NPI 1194840421
  NPD (past)
• Long Beach Memorial Medical

  • Rehabilitation Hospital Unit
  • Long Beach, CA
  • NPI 1396791414
  NPD (past)
• Los Alamitos Medical Center, Inc.

  • Psychiatric Hospital Unit
  • Los Alamitos, CA
  • NPI 1497780084
  NPD (past)
• University of California Irvine

  • General Acute Care Hospital
  • Lakewood, CA
  • NPI 1184655581
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286841600000",
    "number": "1295885630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 E. SOUTH STREET",
            "address_2": "#306",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "90712",
            "telephone_number": "310-378-1915",
            "fax_number": "310-378-6979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 E. SOUTH STREET",
            "address_2": "#306",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "90712",
            "telephone_number": "310-378-1915",
            "fax_number": "310-378-6979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBERG",
        "first_name": "FREDRIC",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2010-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G21402",
            "primary": true
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "CA",
            "license": "G21402",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G21402",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "G21402",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "G21402",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "G21402",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4024334",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G214020",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "G21402",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ12556Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jean Delgado Romualdo-Fernandez, RPH
• Dunja Ronsberger
• Samantha Galang Rorm
• Karla Rosales
• Marilyn Rosca, NURSE PRACTITIONER
• Richard Arthur Rosenberg, DPM
• Bradley Rosenthal, ATC
• Ramiro R. Rosero, MD
• Alani Naeawili Ross, C.M.T.
• Roy Elevazo & Associates, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2010; 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.