GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION
NPI 1154533685
Specialist in San Clemente, CA
NPI Status: Active since May 04, 2007
Contact Information
657 CAMINO DE LOS MARES STE 242
SAN CLEMENTE, CA
ZIP 92673
Phone: (949) 496-6066
Fax: (949) 496-6497
- Organization
- Specialist
- CLIA Number: 05D0934428
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-17-2028
About GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION
This page provides the complete NPI Profile along with additional information for Green Dermatologic Medical Group A Medical Corporation, a provider established in San Clemente, California operating as a Specialist. The healthcare provider is registered in the NPI registry with number 1154533685 assigned on May 2007. The practitioner's primary taxonomy code is 174400000X with license number C36384 (CA). The provider is registered as an organization and their NPI record was last updated 8 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Dr. Roger E Green M. D. (Medical Doctor)
- NPI
- 1154533685
- Provider Name
- GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION
- Entity Type
- Organization
- Location Address
- 657 CAMINO DE LOS MARES STE 242 SAN CLEMENTE, CA 92673
- Location Phone
- (949) 496-6066
- Location Fax
- (949) 496-6497
- Mailing Address
- 657 CAMINO DE LOS MARES STE 242 SAN CLEMENTE, CA 92673
- Mailing Phone
- (949) 496-6066
- Mailing Fax
- (949) 496-6497
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-04-2007
- Last Update Date
- 05-04-2018
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- C36384
- License State
- CA
- Taxonomy Description
- An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D0934428
- Facility Type
- Physician Office
- Certificate Effective Date
- February 18, 2026
- Certificate Expiration Date
- February 17, 2028
- Laboratory Director
- ROGER E. GREEN MD
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Green Dermatologic Medical Group A Medical Corporation after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1154533685, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 55. The final step is to find the difference between that total and the next multiple of ten (60 - 55 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 55 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
SAN CLEMENTE, CA 92673
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154533685, enumerated as an "organization" on May 04, 2007.
The provider is located at 657 CAMINO DE LOS MARES STE 242 SAN CLEMENTE, CA 92673 and the phone number is (949) 496-6066.
Specialist with taxonomy code 174400000X.
