Individual provider Active NPI

Susan Shimomaye, MD

  • MOHS-Micrographic Surgery Physician
  • Oceanside, CA
National Provider Identifier
1801828058
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
G49345 Issued in CA
Practice address
3998 Vista Way Ste 100
Oceanside, CA 92056-4515
Phone
(760) 758-5340
Fax
(760) 758-5502
NPI assigned
Jul 7, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X G49345 CA Primary

Addresses

Primary practice location

3998 Vista Way Ste 100
Oceanside, CA 92056-4515

Mailing address

3998 Vista Way Ste 100
Oceanside, CA 92056-4515
Phone (760) 758-5340

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
I20040324001876 CA Practitioner - Dermatology 1254223464 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of California, Geffen School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatologist Medical Group of North County IncGroup PAC ID 7315849981, 19 clinicians

Practice addresses (Care Compare)

3613 Vista Way
Oceanside, CA 92056-4522
Phone (760) 758-5340

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision229
Removal of tissue1-10
Removal of skin lesions981
Removal of skin cancer352
Removal or shaving of skin growth1-10
Skin biopsy762

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G49345CAMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatologist Medical Group of North County, Inc CurrentSince Aug 1, 1988 Accepting new patients
Tri-City Hospital Past Accepting new patients
Scripps Health Past Accepting new patients

Locations

1200 Garden View Rd
Ste 108
Encinitas, CA 92024
Phone (760) 942-1311

3613 Vista Way
Oceanside, CA 92056
Phone (760) 758-5340

11943 El Camino Real
Ste 220
San Diego, CA 92130
Phone (760) 758-5340

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801828058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3998 VISTA WAY STE 100",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564515",
            "telephone_number": "760-758-5340",
            "fax_number": "760-758-5502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 VISTA WAY STE 100",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564515",
            "telephone_number": "760-758-5340",
            "fax_number": "760-758-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIMOMAYE",
        "first_name": "SUSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "G49345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, CA

Sources for this page

Verify at the official NPI Registry.