NPIMap

Organization Active NPI

Redding Dermatology Medical Group, Inc.

Doing business as CK Derm - Medford

  • Dermatology Physician
  • Medford, OR
National Provider Identifier
1336979046
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
REDDING DERMATOLOGY MEDICAL GROUP, INC.
Doing business as
CK Derm - Medford
Practice address
2924 Siskiyou Blvd Ste 100
Medford, OR 97504-8194
Phone
(541) 930-7777
Fax
(541) 816-4567
NPI assigned
Aug 6, 2024
Last updated
Aug 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Authorized official

Name
Kristina Hernandez
Title
Billing Coordinator
Phone
(530) 241-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

2924 Siskiyou Blvd Ste 100
Medford, OR 97504-8194

Mailing address

2107 Airpark Dr
Redding, CA 96001-2433
Phone (530) 241-7098

Other names 1

  • CK Derm - Medford Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150827000873 OR Part B Supplier - Clinic/Group Practice 2567549504 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Medford, OR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2313483CK Derm Medford2924 Siskiyou Blvd, Ste 100, Medford, OR 97504Provider-performed microscopyOct 30, 2026

National Provider Directory

National Provider Directory

Locations

1817 Concord Ave
Ste 100
Chico, CA 95928
Phone (530) 767-3376

525 2nd St
Ste 219
Eureka, CA 95501
Phone (707) 444-0448

2924 Siskiyou Blvd
Ste 100
Medford, OR 97504
Phone (530) 241-7098

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756252800000",
    "number": "1336979046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2107 AIRPARK DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960012433",
            "telephone_number": "530-241-7098",
            "fax_number": "530-241-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2924 SISKIYOU BLVD STE 100",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048194",
            "telephone_number": "541-930-7777",
            "fax_number": "541-816-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDDING DERMATOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-06",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "530-241-1111"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CK Derm - Medford",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CK Derm - Medford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; 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.