Organization Active NPI

Mismo Dermatology Group Apc

  • Dermatology Physician
  • San Diego, CA
National Provider Identifier
1306405998
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
MISMO DERMATOLOGY GROUP APC
Practice address
8898 Navajo Rd Ste C-349
San Diego, CA 92119-2141
Phone
(619) 303-3704
NPI assigned
Jun 7, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Mr. Steve Springe
Title
Practice Administrator
Phone
(214) 621-4303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

8898 Navajo Rd Ste C-349
San Diego, CA 92119-2141

Mailing address

8898 Navajo Rd Ste C-349
San Diego, CA 92119-2141
Phone (619) 303-3704

Other practice location 1

19929 Greenley Rd
Sonora, CA 95370-5996
Phone (214) 621-4303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190927001616 CA Part B Supplier - Clinic/Group Practice 7012247414 Receives reassigned benefits from 8 practitioners
Practice locations: San Diego, CA; Yuba City, CA; Sonora, CA

National Provider Directory

National Provider Directory

Locations

6280 Jackson Dr
Ste 9
San Diego, CA 92119
Phone (619) 303-3642

8898 Navajo Rd
#C349
San Diego, CA 92119
Phone (214) 621-4303

8898 Navajo Rd
Ste C349
San Diego, CA 92119
Phone (619) 303-3704

8898 Navajo Rd
Ste C
San Diego, CA 92119

19929 Greenley Rd
#1112
Sonora, CA 95370
Phone (619) 303-3704

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1306405998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8898 NAVAJO RD STE C-349",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921192141",
            "telephone_number": "619-303-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8898 NAVAJO RD STE C-349",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921192141",
            "telephone_number": "619-303-3704"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19929 Greenley Rd",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953705996",
            "country_code": "US",
            "telephone_number": "214-621-4303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISMO DERMATOLOGY GROUP APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-07",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "SPRINGE",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "214-621-4303",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; 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.