GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION
NPI 1154533685
Specialist in San Clemente, CA

Q: What is Green Dermatologic Medical Group A Medical Corporation's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since May 04, 2007CLIA 05D0934428 · Certificate of Compliance

657 CAMINO DE LOS MARES STE 242, SAN CLEMENTE, CA 92673(949) 496-6066(949) 496-6497 Get Directions Write a Review

NPPES record last updated: May 4, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Green Dermatologic Medical Group A Medical Corporation NPPES

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

GREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION (NPI 1154533685) is a healthcare organization registered as a specialist in San Clemente, California and active in the NPI registry since May 2007. The organization holds a CLIA Certificate of Compliance certificate valid through February 17, 2028 and lists Roger E Green, Medical Doctor, as its authorized official.

NPPES Registry Identity

NPI1154533685

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameGREEN DERMATOLOGIC MEDICAL GROUP A MEDICAL CORPORATION

Location Address657 CAMINO DE LOS MARES STE 242San Clemente, CA 92673-2811

Mailing Address657 Camino De Los Mares Ste 242San Clemente, CA 92673-2811 · (949) 496-6066 · Fax (949) 496-6497

Phone(949) 496-6066

Fax(949) 496-6497

Organization SubpartNo

Authorized OfficialRoger E GreenMedical Doctor · (949) 496-6066

Enumeration DateMay 4, 2007

Last NPPES UpdateMay 4, 2018

✔ NPI 1154533685 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in CA · C36384

Definition

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.

657 CAMINO DE LOS MARES STE 242, San Clemente, CA 92673

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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)

Green Dermatologic Medical Group A Medical Corporation is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Green Dermatologic Medical Group A Medical Corporation, which bills Medicare for the services this clinician delivers.

Clinician (1)

Roger Green, MD

Dermatology

NPI 1215917968

657 CAMINO DE LOS MARES SUITE 242
San Clemente, CA 92673

(949) 496-6066

✔ PECOS✔ Accepts MedicareSame address

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 05D0934428

Green Dermatologic Medical Group · San Clemente, CA

Active · expires Feb 17, 2028

CLIA Number05D0934428

Laboratory TypePhysician Office

Certificate Effective DateFebruary 18, 2026

Certificate Expiration DateFebruary 17, 2028

Laboratory DirectorRoger E. Green MD

Laboratory Phone(949) 496-6066

Laboratory LocationGreen Dermatologic Medical Group657 Camino De Los Mares, Ste 242, San Clemente, CA 92673

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 Green Dermatologic Medical Group A Medical Corporation's NPI number?

The NPI number for Green Dermatologic Medical Group A Medical Corporation is 1154533685. It was assigned to this organization in the NPPES registry on May 4, 2007.

Where is Green Dermatologic Medical Group A Medical Corporation located?

Green Dermatologic Medical Group A Medical Corporation is located at 657 Camino De Los Mares Ste 242, San Clemente, CA 92673. The listed phone number is (949) 496-6066.

What is Green Dermatologic Medical Group A Medical Corporation's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Green Dermatologic Medical Group A Medical Corporation enrolled in Medicare?

Yes. Green Dermatologic Medical Group A Medical Corporation is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Green Dermatologic Medical Group A Medical Corporation?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Green Dermatologic Medical Group A Medical 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Green Dermatologic Medical Group A Medical Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D0934428) is associated with this NPI, valid through February 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Green Dermatologic Medical Group A Medical Corporation was last updated on May 4, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.