NPIMap

Organization Active NPI

Green Dermatologic Medical Group a Medical Corporation

  • Specialist
  • Laguna Hills, CA
National Provider Identifier
1821116054
Registry record updated May 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION
Practice address
24411 Health Center Dr Ste 520
Laguna Hills, CA 92653-3633
Phone
(949) 452-3841
Fax
(949) 859-8937
NPI assigned
Mar 26, 2007
Last updated
May 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2018

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

Authorized official

Name
Dr. Rollin M Green, M.D.NPI 1245206705
Title
President
Phone
(949) 452-3841

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

24411 Health Center Dr Ste 520
Laguna Hills, CA 92653-3633

Mailing address

24411 Health Center Dr Ste 520
Laguna Hills, CA 92653-3633
Phone (949) 452-3841

National Provider Directory

National Provider Directory
Tax ID family
Walter S Green MD Medical Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

657 Camino de los Mares
San Clemente, CA 92673
Phone (949) 489-9039

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1821116054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24411 HEALTH CENTER DR STE 520",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533633",
            "telephone_number": "949-452-3841",
            "fax_number": "949-859-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24411 HEALTH CENTER DR STE 520",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533633",
            "telephone_number": "949-452-3841",
            "fax_number": "949-859-8937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "ROLLIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-452-3841",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.