DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC (AMERICAN WEST SKIN PATHOLOGY CONSULTATION SERVICE) - NPI NUMBER 1548456825

Summary

Provider Name: DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC (AMERICAN WEST SKIN PATHOLOGY CONSULTATION SERVICE)

NPI Number: 1548456825

Clasification: Allergy & Immunology (207K00000X)

Address:
1007 LIVE OAK BLVD
STE A-1
YUBA CITY, CA
ZIP 95991

Phone Number: (530) 673-3790



Detailed Information

DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC is an allergist in Yuba City, CA. The provider is an allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. The assigned NPI number for this provider is 1548456825 and is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As American West Skin Pathology Consultation Service.

The provider's business address is:

1007 LIVE OAK BLVD
STE A-1
YUBA CITY, CA
ZIP 95991-454
Phone: (530) 673-3790
Fax: (530) 673-5642

The provider's authorized official is Leon Melvin Edelstein .
The authorized official title is President and has the following contact phone number (530) 673-3790.

The enumeration date for this NPI number is 9/19/2007 and was last updated on 9/19/2007.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1023177870 DR. LEON MELVIN EDELSTEIN, M.D.
Allergy & Immunology
1184611048 FOY WALLACE COX, M.D.
Allergy & Immunology (Allergy)





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207K00000X Allergy & Immunology 00A192080 CA No
2 207N00000X Dermatology 00A192080 CA No
3 207NP0225X Dermatology Pediatric Dermatology 00A192080 CA No
4 207NS0135X Dermatology Procedural Dermatology 00A192080 CA No
5 207ZD0900X Pathology Dermatopathology 00A192080 CA No
6 207ZI0100X Pathology Immunopathology 00A192080 CA No
7 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology 00A192080 CA No
8 207ZP0213X Pathology Pediatric Pathology 00A192080 CA No
9 208D00000X General Practice 00A192080 CA No
10 209800000X Legal Medicine 00A192080 CA No
11 207ND0900X Dermatology Dermatopathology 00A192080 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 A21651 MEDICARE UPIN CA
2 00A192080 MEDICAID CA
3 ZZZ29262Z MEDICARE OSCAR/CERTIFICATION CA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1548456825 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name AMERICAN WEST SKIN PATHOLOGY CONSULTATION SERVICE Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 1007 LIVE OAK BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address STE A-1 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name YUBA CITY The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 959913454 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 5306733790 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 5306735642 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 9/19/2007 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 9/19/2007 The date that a record was last updated or changed.
17 Authorized Official Last Name EDELSTEIN The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name LEON The first name of the authorized official.
19 Authorized Official Middle Name MELVIN The middle name of the authorized official.
20 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
21 Authorized Official Telephone Number 5306733790 The 10-position telephone number of the authorized official.
22 Healthcare Provider Taxonomy Code 1 207K00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
23 Provider License Number 1 00A192080 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
24 Provider License Number State Code 1 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
25 Healthcare Provider Primary Taxonomy Switch 1 N
26 Healthcare Provider Taxonomy Code 2 207N00000X
27 Provider License Number 2 00A192080 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
28 Provider License Number State Code 2 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
29 Healthcare Provider Primary Taxonomy Switch 2 N
30 Healthcare Provider Taxonomy Code 3 207NP0225X
31 Provider License Number 3 00A192080 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
32 Provider License Number State Code 3 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
33 Healthcare Provider Primary Taxonomy Switch 3 N
34 Healthcare Provider Taxonomy Code 4 207NS0135X
35 Provider License Number 4 00A192080 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
36 Provider License Number State Code 4 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
37 Healthcare Provider Primary Taxonomy Switch 4 N
38 Healthcare Provider Taxonomy Code 5 207ZD0900X
39 Provider License Number 5 00A192080 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
40 Provider License Number State Code 5 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
41 Healthcare Provider Primary Taxonomy Switch 5 N
42 Healthcare Provider Taxonomy Code 6 207ZI0100X
43 Provider License Number 6 00A192080
44 Provider License Number State Code 6 CA
45 Healthcare Provider Primary Taxonomy Switch 6 N
46 Healthcare Provider Taxonomy Code 7 207ZP0102X
47 Provider License Number 7 00A192080
48 Provider License Number State Code 7 CA
49 Healthcare Provider Primary Taxonomy Switch 7 N
50 Healthcare Provider Taxonomy Code 8 207ZP0213X
51 Provider License Number 8 00A192080
52 Provider License Number State Code 8 CA
53 Healthcare Provider Primary Taxonomy Switch 8 N
54 Healthcare Provider Taxonomy Code 9 208D00000X
55 Provider License Number 9 00A192080
56 Provider License Number State Code 9 CA
57 Healthcare Provider Primary Taxonomy Switch 9 N
58 Healthcare Provider Taxonomy Code 10 209800000X
59 Provider License Number 10 00A192080
60 Provider License Number State Code 10 CA
61 Healthcare Provider Primary Taxonomy Switch 10 N
62 Healthcare Provider Taxonomy Code 11 207ND0900X
63 Provider License Number 11 00A192080
64 Provider License Number State Code 11 CA
65 Healthcare Provider Primary Taxonomy Switch 11 Y
66 Other Provider Identifier 1 A21651 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
67 Other Provider Identifier Type Code 1 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
68 Other Provider Identifier State 1 CA
69 Other Provider Identifier 2 00A192080 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
70 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
71 Other Provider Identifier State 2 CA
72 Other Provider Identifier 3 ZZZ29262Z Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
73 Other Provider Identifier Type Code 3 06 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
74 Other Provider Identifier State 3 CA
75 Is Organization Subpart Y
76 Parent Organization LBN DERMATOLOGY PATHOLOGY MEDICAL GROUP, INC
77 Parent Organization TIN
78 Authorized Official Name Prefix Text DR.
79 Authorized Official Credential Text M.D.
80 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP
81 Healthcare Provider Taxonomy Group 2 193400000X MULTIPLE SINGLE SPECIALTY GROUP
82 Healthcare Provider Taxonomy Group 3 193400000X MULTIPLE SINGLE SPECIALTY GROUP
83 Healthcare Provider Taxonomy Group 4 193400000X MULTIPLE SINGLE SPECIALTY GROUP
84 Healthcare Provider Taxonomy Group 5 193400000X MULTIPLE SINGLE SPECIALTY GROUP
85 Healthcare Provider Taxonomy Group 6 193400000X MULTIPLE SINGLE SPECIALTY GROUP
86 Healthcare Provider Taxonomy Group 7 193400000X MULTIPLE SINGLE SPECIALTY GROUP
87 Healthcare Provider Taxonomy Group 8 193400000X MULTIPLE SINGLE SPECIALTY GROUP
88 Healthcare Provider Taxonomy Group 9 193400000X MULTIPLE SINGLE SPECIALTY GROUP
89 Healthcare Provider Taxonomy Group 10 193400000X MULTIPLE SINGLE SPECIALTY GROUP
90 Healthcare Provider Taxonomy Group 11 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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