Kevin Tate Belasco, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

20A12076 Issued in CA

Practice address

1501 Superior Ave Ste 115
Newport Beach, CA 92663-3606

Phone

(949) 640-7546

Fax

(949) 640-7547

NPI assigned

Apr 9, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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 Osteopathy

State licenses

Practice roles

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.

• Blue Harbor Dermatology Inc

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1962829457
  Medicare reassignment Authorized official
• Hoag Memorial Hospital Presbyterian

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1518951300
  NPD (past)
• Ascension St Francis Hospital, Inc

  • General Acute Care Hospital
  • Milwaukee, WI
  • NPI 1225087190
  NPD (past)
• Aurora Health Care North, Inc.

  • General Acute Care Hospital
  • Two Rivers, WI
  • NPI 1477508687
  NPD (past)

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1578736724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SUPERIOR AVE STE 115",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633606",
            "telephone_number": "949-640-7546",
            "fax_number": "949-640-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SUPERIOR AVE STE 115",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633606",
            "telephone_number": "949-640-7546",
            "fax_number": "949-640-7547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELASCO",
        "first_name": "KEVIN",
        "middle_name": "TATE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "51343021",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "20A12076",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NV",
            "license": "DO1741",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "001417140",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00690402",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "51343-021",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578736724",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yanina D Beck
• Vance B Becker, PH.D.
• Mahnaz Behboodikhah, MD
• Susan Beisner, LMFT
• Amy Megan Belanger, M.A. AMFT #145262
• Carlo Bell
• Tera Lee Bell
• Bella Team LTD.
• Belling Chiropractic, Inc.
• Bellman Group, Inc.

• Dermatology Physician in Newport Beach, CA
• Providers in Newport 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 7, 2023; 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.