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MEDDERM ASSOCIATES
NPI 1063447936
Dermatology in San Diego, CA

Active since July 11, 2006CLIA 05D1062915 · Certificate of Compliance
3965 5TH AVE STE 200, SAN DIEGO, CA 92103(619) 542-0013(619) 542-0559 Get Directions Write a Review

NPPES record last updated: April 18, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Medderm Associates NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDDERM ASSOCIATES (NPI 1063447936) is a healthcare organization registered as a dermatology in San Diego, California and active in the NPI registry since July 2006. The organization holds a CLIA Certificate of Compliance certificate valid through September 24, 2027 and lists Michelle Terez Pelle, Owner/director, as its authorized official.

NPPES Registry Identity

NPI1063447936
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMEDDERM CORPORATION
Location Address3965 5TH AVE STE 200San Diego, CA 92103-3107
Mailing Address3965 5th Ave Ste 200San Diego, CA 92103-3107 · (619) 542-0013 · Fax (619) 542-0559
Phone(619) 542-0013
Fax(619) 542-0559
Organization SubpartNo
Authorized OfficialMichelle Terez PelleOwner/director · (619) 542-0013
Enumeration DateJuly 11, 2006
Last NPPES UpdateApril 18, 2023
NPPES CertifiedApril 18, 2023
✔ NPI 1063447936 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in CA · A88009
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
3965 5TH AVE STE 200, San Diego, CA 92103
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Other Names 1

Doing Business AsMedderm Associates

Other Identifiers 1

Medicaid00A880090CA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Medderm Associates is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

7

Medicare enrollment records show 7 clinicians reassign Medicare billing to Medderm Associates, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (7)

Michael Lee, M.D.
Dermatology
NPI 1255607685
3965 5TH AVE STE 200
San Diego, CA 92103
(619) 542-0013
✔ PECOS✔ Accepts MedicareSame address
Michelle Pelle, M.D.
Dermatology
NPI 1043252786
3965 5TH AVE STE 200
San Diego, CA 92103
(619) 542-0013
✔ PECOS✔ Accepts MedicareSame address
Patrick Blake, MD
Dermatology
NPI 1871817312
501 WASHINGTON ST SUITE 502
San Diego, CA 92103
(619) 542-0013
✔ PECOS✔ Accepts MedicareSame address
Judy Doong, MD
Dermatology
NPI 1215326236
6536 S MCCARRAN BLVD STE B
Reno, NV 89509
(775) 982-8255
✔ PECOS✔ Accepts Medicare487 mi
Jay Blake, NP
Nurse Practitioner
NPI 1619284742
920 COUNTRY CLUB RD STE 140A
Eugene, OR 97401
(971) 915-8585
✔ PECOS✔ Accepts Medicare844 mi
Sarah Moore, MD
Dermatology
NPI 1265994891
101 W 8TH AVE
Spokane, WA 99204
(913) 309-2021
✔ PECOS✔ Accepts Medicare1,028 mi
Bao Vincent Ho, MD
Dermatology
NPI 1629728928
3901 RAINBOW BLVD
Kansas City, KS 66160
(316) 516-0039
✔ PECOS✔ Accepts Medicare1,333 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 05D1062915

Medderm Associates, Inc · San Diego, CA
Active · expires Sep 24, 2027
CLIA Number05D1062915
Laboratory TypePhysician Office
Certificate Effective DateSeptember 25, 2025
Certificate Expiration DateSeptember 24, 2027
Laboratory DirectorMichelle T. Pelle MD
Laboratory Phone(619) 542-0013
Laboratory LocationMedderm Associates, Inc3965 5th Ave, Ste 200, San Diego, CA 92103
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Medderm Corporation's NPI number?

The NPI number for Medderm Corporation is 1063447936. It was assigned to this organization in the NPPES registry on July 11, 2006. The provider is doing business as Medderm Associates.

Where is Medderm Corporation located?

Medderm Corporation is located at 3965 5th Ave Ste 200, San Diego, CA 92103. The listed phone number is (619) 542-0013.

What is Medderm Corporation's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Medderm Corporation enrolled in Medicare?

Yes. Medderm Corporation is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Medderm Corporation?

According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Medderm Corporation. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (6) and Nurse Practitioner (1). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Medderm Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D1062915) is associated with this NPI, valid through September 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Medderm Corporation was last updated on April 18, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.