Blue Harbor Dermatology Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

20A12076 Issued in CA

Legal business name

BLUE HARBOR DERMATOLOGY INC

Practice address

1501 Superior Ave
Suite 115
Newport Beach, CA 92663-3600

Phone

(214) 395-2221

NPI assigned

Mar 24, 2014

Organization subpart

No

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

Authorized official

Name

Kevin Belasco, MDNPI 1578736724

Title

Physician

Phone

(800) 828-2012

Specialties & licenses 1

Addresses

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

Practitioners 1

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

• Kevin Tate Belasco, D.O.

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1578736724
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395619200000",
    "number": "1962829457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 SUPERIOR AVE",
            "address_2": "SUITE 115",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SUPERIOR AVE",
            "address_2": "SUITE 115",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633600",
            "telephone_number": "214-395-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HARBOR DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-24",
        "last_updated": "2014-03-24",
        "status": "A",
        "authorized_official_last_name": "BELASCO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "800-828-2012",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "20A12076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Blenker, DC
• Katherine Sherman Blevins, M.D., PH.D.
• Barton J Blinder, M.D.
• Bloom Counseling and Consulting, Inc
• Jeffrey Howard Bloom, D.O.
• Michelle Blue
• Anthony Thomas Bober, M.S.,M.F.T.
• Sarah Bobich, PA-C
• Hillel Bocian, MD
• Bonnie Virginia Bock, MD

• Dermatology Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; 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.