GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION
NPI 1174898654
Dermatology in Greenbrae, CA
NPI Status: Active since March 15, 2012
Contact Information
1300 S ELISEO DR STE 207
GREENBRAE, CA
ZIP 94904
Phone: (415) 925-0550
Fax: (415) 925-9062
- Organization
- Dermatology
- CLIA Number: 05D0686425
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-31-2026
About GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION
This page provides the complete NPI Profile along with additional information for Greenbrae Dermatology, A Medical Corporation, a provider established in Greenbrae, California operating as a Dermatology. The healthcare provider is registered in the NPI registry with number 1174898654 assigned on March 2012. The practitioner's primary taxonomy code is 207N00000X with license number G53455 (CA). The provider is registered as an organization and their NPI record was last updated 11 years ago. Greenbrae Dermatology, A Medical Corporation operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Mrs. Lucretia Ann Lewitt (Practice Manager)
- NPI
- 1174898654
- Provider Name
- GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION
- Entity Type
- Organization
- Location Address
- 1300 S ELISEO DR STE 207 GREENBRAE, CA 94904
- Location Phone
- (415) 925-0550
- Location Fax
- (415) 925-9062
- Mailing Address
- 1300 S ELISEO DR STE 207 GREENBRAE, CA 94904
- Mailing Phone
- (415) 925-0550
- Mailing Fax
- (415) 925-9062
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-15-2012
- Last Update Date
- 06-30-2015
- Code Navigator
A dermatologist like Greenbrae Dermatology, A Medical Corporation is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.
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
Dermatology
- Taxonomy Code
- 207N00000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- G53455
- License State
- CA
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | A97783 (CA) |
| 2 | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | G40606 (CA) |
| 3 | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology | A97783 (CA) |
| 4 | 207ND0900X | Allopathic & Osteopathic Physicians | Dermatology | G53455 (CA) |
| 5 | 207ND0900X | Allopathic & Osteopathic Physicians | Dermatology | A97783 (CA) |
| 6 | 207NP0225X | Allopathic & Osteopathic Physicians | Dermatology | G53455 (CA) |
| 7 | 207NP0225X | Allopathic & Osteopathic Physicians | Dermatology | A97783 (CA) |
| 8 | 207NP0225X | Allopathic & Osteopathic Physicians | Dermatology | G40606 (CA) |
| 9 | 207NS0135X | Allopathic & Osteopathic Physicians | Dermatology | G53455 (CA) |
| 10 | 207NS0135X | Allopathic & Osteopathic Physicians | Dermatology | A97783 (CA) |
| 11 | 207NS0135X | Allopathic & Osteopathic Physicians | Dermatology | G40606 (CA) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas 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
- 05D0686425
- Facility Type
- Physician Office
- Certificate Effective Date
- January 01, 2025
- Certificate Expiration Date
- December 31, 2026
- Laboratory Director
- DR. BENJAMIN NICHOLS
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Greenbrae Dermatology, 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 1174898654, we treat the final digit (4) 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 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).
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 66 is 70. 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.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1174898654, enumerated as an "organization" on March 15, 2012.
The provider is located at 1300 S ELISEO DR STE 207 GREENBRAE, CA 94904 and the phone number is (415) 925-0550.
Dermatology with taxonomy code 207N00000X.
