Norcal Skin Disease and Surgery Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

A55665 Issued in CA

Legal business name

NORCAL SKIN DISEASE AND SURGERY INC

Doing business as

NorCal Dermatology Medical Surgical Cosmetic

Practice address

196 Wikiup Dr
Santa Rosa, CA 95403-7773

Phone

(707) 527-9517

Fax

(707) 527-9913

NPI assigned

Dec 10, 2008

Last updated

Nov 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alicia Brophy, CMOM, CMA

Title

Practice Manager

Phone

(707) 527-9517

Specialties & licenses 1

Addresses

Other names 1

• NorCal Dermatology Medical Surgical Cosmetic Doing business as

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 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.

• Henry Eric Degroot, MD

  • Dermatology Physician
  • Santa Rosa, CA
  • NPI 1346260411
  Medicare reassignment Care Compare group NPD
• Khanh Yen Truong, M.D.

  • Dermatology Physician
  • Santa Rosa, CA
  • NPI 1619962552
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1881839520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 WIKIUP DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954037773",
            "telephone_number": "707-527-9517",
            "fax_number": "707-527-9913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 WIKIUP DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954037773",
            "telephone_number": "707-527-9517",
            "fax_number": "707-527-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORCAL SKIN DISEASE AND SURGERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "BROPHY",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "707-527-9517",
        "authorized_official_credential": "CMOM, CMA"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "A55665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorCal Dermatology Medical Surgical Cosmetic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NorCal Dermatology Medical Surgical Cosmetic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barbara Kaylin Noblin, MFT
• Thomas Eugene Nocera, FNP
• Allison Noesekabel
• Marina Nojima
• Megan Nolan
• Norcal Specialty Surgery Center, LLC
• Karen Nordback
• Karen E Nordeen, LMFT
• Norman Pang MD
• Norman Pang MD

• Medical Specialty Clinic/Center in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; 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.