William J Wickwire M D Inc a Professional Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

G650830 Issued in CA

Legal business name

WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION

Doing business as

Beach Cities Dematology Med Center

Practice address

520 N Prospect Ave
Ste 302
Redondo Beach, CA 90277-3041

Phone

(310) 798-1515

Fax

(310) 798-3131

NPI assigned

Nov 13, 2006

Last updated

Mar 24, 2022By 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

Neal M Ammar, M.DNPI 1851460950

Title

Ceo

Phone

(310) 798-1515

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Beach Cities Dematology Med Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 15

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.

• Neal M Ammar, M.D.

  • Dermatology Physician
  • Redondo Beach, CA
  • NPI 1851460950
  Medicare reassignment Care Compare group NPD Authorized official
• Adam Brody Aronson, M.D.

  • MOHS-Micrographic Surgery Physician
  • Sherman Oaks, CA
  • NPI 1629465778

  Dermatology

  Medicare reassignment Care Compare group NPD
• Pascal Ferzli, M.D.

  • Dermatology Physician
  • Seal Beach, CA
  • NPI 1396906921
  Medicare reassignment Care Compare group NPD
• Jeffrey Keith Lander, M.D., PH.D.

  • Dermatology Physician
  • Irvine, CA
  • NPI 1174566046
  Medicare reassignment Care Compare group NPD
• Kelly Tram Tran, PA-C

  • Physician Assistant
  • Redondo Beach, CA
  • NPI 1487295549
  Medicare reassignment Care Compare group NPD
• William James Wickwire, MD

  • Dermatology Physician
  • Redondo Beach, CA
  • NPI 1699779660
  Medicare reassignment Care Compare group NPD
• Geover Fernandez, MD

  • MOHS-Micrographic Surgery Physician
  • Redondo Beach, CA
  • NPI 1639103138
  Medicare reassignment Care Compare group
• Amit Patel, PA-C

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1396409884
  Medicare reassignment Care Compare group
• Fariba Seraj, NP/PA

  • Nurse Practitioner
  • Redondo Beach, CA
  • NPI 1346268919
  Medicare reassignment Care Compare group
• Erik Patrick Sorenson, PA-C

  • Physician Assistant
  • Lakewood, CA
  • NPI 1720109614
  Medicare reassignment Care Compare group
• Linda Globerman, MD

  • Specialist
  • Irvine, CA
  • NPI 1407835952
  Medicare reassignment NPD
• Yasmin Qaseem, M.D.

  • Dermatology Physician
  • Torrance, CA
  • NPI 1396107314
  Medicare reassignment NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1326119165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 N PROSPECT AVE",
            "address_2": "STE 302",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773041",
            "telephone_number": "310-798-1515",
            "fax_number": "310-798-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N PROSPECT AVE",
            "address_2": "STE 302",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773041",
            "telephone_number": "310-798-1515",
            "fax_number": "310-798-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM J WICKWIRE M D INC A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "AMMAR",
        "authorized_official_first_name": "NEAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-798-1515",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "G650830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NORTHERN CA ID",
            "identifier": "00G650830",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G650830",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beach Cities Dematology Med Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charlotte Wiethoff-Bradley, MFT
• Mary Wiggins, LMFT, LPCC
• Dennis E Wild, DC
• Jamie Wilhelm
• Yasmine Wilhite
• Mercedes Williams-Brown, MS
• Kaegun Williams
• Kristen Kay Williams, M.S.W.
• Mark H Williams, O.D.
• Dane R Wimmer, MD

• Dermatology Physician in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.