NPIMap

Organization Active NPI

Solano Dermatology Associates Inc

  • Dermatology Physician
  • Vallejo, CA
National Provider Identifier
1922052729
Registry record updated Oct 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SOLANO DERMATOLOGY ASSOCIATES INC
Practice address
2290 Sacramento St
Vallejo, CA 94590-2929
Phone
(707) 643-5785
Fax
(707) 643-8810
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2007

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

Authorized official

Name
John Kevin Geisse, M.D.NPI 1275571028
Title
Owner
Phone
(707) 643-5785

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
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

2290 Sacramento St
Vallejo, CA 94590-2929

Mailing address

2290 Sacramento St
Vallejo, CA 94590-2929
Phone (707) 643-5785

Other identifiers 1

IdentifierTypeStateIssuer
GR0023150MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060928000473 CA Part B Supplier - Clinic/Group Practice 6305840422 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
Practice locations: Vallejo, CA; Fairfield, CA; Vacaville, CA; Saint Helena, CA

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0685517Solano Dermatology Associates2290 Sacramento St, Vallejo, CA 94590ComplianceMay 31, 2027

National Provider Directory

National Provider Directory

Locations

480 Chadbourne Rd
Ste 102
Fairfield, CA 94534
Phone (707) 399-4500

480 Chadbourne Rd
Fairfield, CA 94534
Phone (707) 372-9083

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)…

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1922052729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 SACRAMENTO ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945902929",
            "telephone_number": "707-643-5785",
            "fax_number": "707-643-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 SACRAMENTO ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945902929",
            "telephone_number": "707-643-5785",
            "fax_number": "707-643-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLANO DERMATOLOGY ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "GEISSE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-643-5785",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0023150",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; 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.