Accredited Dermatology Medical Clinic Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ACCREDITED DERMATOLOGY MEDICAL CLINIC INC

Practice address

301 W Bastanchury Road
Suite 245
Fullerton, CA 92835

Phone

(714) 525-3500

Fax

(714) 525-3588

NPI assigned

Sep 8, 2006

Organization subpart

No

Name

Patrick Robert Dahl, MDNPI 1033213392

Title

Physician

Phone

(714) 525-3500

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

• Patrick Robert Dahl, MD

  • Dermatology Physician
  • Fullerton, CA
  • NPI 1033213392

  CA, Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Kristina A Holmkvist, M.D.

  • Dermatology Physician
  • Fullerton, CA
  • NPI 1194772822

  CA, Dermatology

  Medicare reassignment Care Compare group NPD

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871697136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5859",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92838",
            "telephone_number": "714-525-3500",
            "fax_number": "714-525-3588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W BASTANCHURY ROAD",
            "address_2": "SUITE 245",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92835",
            "telephone_number": "714-525-3500",
            "fax_number": "714-525-3588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCREDITED DERMATOLOGY MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAHL",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "714-525-3500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jorrell Abucejo, PHARM D
• Leila Abuhadba
• Alison Abuhamad
• Kimberly Aburto
• Yasmen Abuyousef
• Jennifer Rose Acevedo
• Karina Acevedo
• Christine L Aceves, PSYD
• Diane Carolina Aceves
• Yosselin Abigail Aceves

• All providers in Fullerton, CA
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.