Alamitos Dermatological Medical Clinic a Professional Corp

Key facts

NPI: 1891986204
Entity type: Organization (NPI type 2)
Primary specialty: Specialist 174400000X
Legal business name: ALAMITOS DERMATOLOGICAL MEDICAL CLINIC A PROFESSIONAL CORP
Practice address: 12721 Newport Ave
Suite 4
Tustin, CA 92780-8030
Phone: (714) 838-5680
Fax: (714) 544-1321
NPI assigned: Aug 9, 2007
Organization subpart: No

Authorized official

Name: Monica T Dennis
Title: Administrator
Phone: (562) 619-8440

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Alamitos Dermatological Medical Clinic a Professional Corp Specialist · Los Alamitos, CA · NPI 1750509444

Same enrollment O20040514001203
Alamitos Dermatological Medical Clinic a Professional Corp Specialist · Mission Viejo, CA · NPI 1801087218

Same enrollment O20040514001203
Alamitos Dermatological Medical Clinic a Professional Corp Specialist · Huntington Beach, CA · NPI 1811188212

Same enrollment O20040514001203

Practitioners 6

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

Michael Arnstein, M.D. Specialist · Torrance, CA · NPI 1821000100

Medicare reassignment Care Compare group NPD CA · SPECIALIST
Sidney B Newman, M.D. Specialist · Los Alamitos, CA · NPI 1235222860

Medicare reassignment Care Compare group NPD CA · SPECIALIST
Charles David Rosenberg, M.D. Specialist · Huntington Beach, CA · NPI 1134212681

Medicare reassignment Care Compare group NPD CA · SPECIALIST
Matthew Bart Luxenberg, MD Specialist · Los Alamitos, CA · NPI 1548353121

Medicare reassignment Care Compare group CA
Michael Anthony Radonich, M.D. Specialist · Los Alamitos, CA · NPI 1053404681

Medicare reassignment Care Compare group CA
James T Wang, M.D. Dermatology Physician · Rancho Santa Margarita, CA · NPI 1013091396

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040514001203	CA	Part B Supplier - Clinic/Group Practice	3971593542	Receives reassigned benefits from 5 practitioners 3 other NPIs on this enrollment Practice locations: Huntington Beach, CA; Los Alamitos, CA; Mission Viejo, CA; Tustin, CA

National Provider Directory

Locations

5451 La Palma Ave
Ste 27
La Palma, CA 90623
Phone (714) 523-9493

1401 Avocado Ave
Ste 710
Newport Beach, CA 92660
Phone (714) 640-1611

13372 Newport Ave
Ste H
Tustin, CA 92780
Phone (714) 838-5680

12721 Newport Ave
Ste 4
Tustin, CA 92780
Phone (714) 838-5680

12721 Newport Ave
Tustin, CA 92780
Phone (714) 838-5680

Networks

BSC 65 PLUS INDIVIDUAL MAPD
Plans: 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)…

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Specialist Group: 193400000X SINGLE SPECIALTY GROUP	174400000X			Yes

Addresses

Primary practice location

12721 Newport Ave
Suite 4
Tustin, CA 92780-8030

Mailing address

12721 Newport Ave
Suite 4
Tustin, CA 92780-8030
Phone (714) 838-5680

Other providers in Tustin, CA

All providers in Tustin, CA · Specialist in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.