Peninsula Dermatologic Surgery Inc

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

PENINSULA DERMATOLOGIC SURGERY INC

Practice address

321 Middlefield Rd # 245
Menlo Park, CA 94025-3564

Phone

(650) 326-7222

Fax

(650) 326-7332

NPI assigned

Dec 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jon C. Starr, M.D.NPI 1972612083

Title

Ceo

Phone

(650) 326-7222

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

Practitioners 5

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

• Jon C Starr, M.D.

  • MOHS-Micrographic Surgery Physician
  • Menlo Park, CA
  • NPI 1972612083
  Medicare reassignment Care Compare group NPD Authorized official
• Caroline Doo

  • MOHS-Micrographic Surgery Physician
  • Menlo Park, CA
  • NPI 1750736898
  Medicare reassignment Care Compare group NPD
• Tara D Miller, MD

  • Dermatology Physician
  • Menlo Park, CA
  • NPI 1477685907
  Medicare reassignment Care Compare group NPD
• Nancy Hsieh, PA-C

  • Medical Physician Assistant
  • Menlo Park, CA
  • NPI 1750665444
  Medicare reassignment Care Compare group
• Khosrow Mehrany, M.D.

  • Specialist
  • Modesto, CA
  • NPI 1235123142
  NPD (past)

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

{
    "created_epoch": "1230508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239321600000",
    "number": "1598901340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 MIDDLEFIELD RD # 245",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940253564",
            "telephone_number": "650-326-7222",
            "fax_number": "650-326-7332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 MIDDLEFIELD RD # 245",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940253564",
            "telephone_number": "650-326-7222",
            "fax_number": "650-326-7332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA DERMATOLOGIC SURGERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-29",
        "last_updated": "2009-04-10",
        "status": "A",
        "authorized_official_last_name": "STARR",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-326-7222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Pederson
• Benjamin Jeffrey Peipert, MD
• Peter Pellionisz, MD, PHD
• Jose M Pena
• Peninsula Associates Speech Therapy Services, Inc.
• Peninsula Private Neurology Inc
• Peninsula Specialty Speech Therapy, PC
• Peninsula Volunteers, Inc.
• Juan Damian Perez, LMSW
• Personalis, Inc.

• MOHS-Micrographic Surgery Physician in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• MOHS-Micrographic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2009; 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.