Individual provider Active NPI

David J. Sire, M.D.

  • Dermatology Physician
  • Fullerton, CA
National Provider Identifier
1710046628
Registry record updated May 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A22972 Issued in CA
Practice address
301 W Bastanchury Rd Ste 140
Fullerton, CA 92835
Phone
(714) 882-5525
NPI assigned
Dec 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A22972 CA Primary

Addresses

Primary practice location

301 W Bastanchury Rd Ste 140
Fullerton, CA 92835

Mailing address

26935 Calle Dolores
Dana Point, CA 92624-1609
Phone (949) 433-2830

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080611000797 CA Practitioner - Dermatology 2668458639

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 1967
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2720 N Harbor Blvd
Suite 205
Fullerton, CA 92835-2609

301 W Bastanchury Rd
Suite 125
Fullerton, CA 92835-3423

Merit-based Incentive Payment System (MIPS)

Final score
96.33 of 100Reported as individual
Quality
93.33
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision16
Removal of tissue1-10
Removal of skin lesions486
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A22972CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Martin H. Kay, PH. D. MD a Medical Corporation Dermatology Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1710046628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26935 CALLE DOLORES",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926241609",
            "telephone_number": "949-433-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W BASTANCHURY RD STE 140",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92835",
            "telephone_number": "714-882-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIRE",
        "first_name": "DAVID",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A22972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.