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GLENN A. KOBY, MD
NPI 1275622664
Specialist in Petaluma, CA

Active since October 12, 2006
106 LYNCH CREEK WAY, SUITE #8, PETALUMA, CA 94954(707) 763-6816(707) 763-1730 Get Directions Write a Review

NPPES record last updated: June 25, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Glenn A. Koby, Md NPPES

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

GLENN A. KOBY, MD (NPI 1275622664), doing business as North Bay Dermatology, is a healthcare organization registered as a specialist in Petaluma, California and active in the NPI registry since October 2006. The organization lists Santiago Centurion, Practice Owner, as its authorized official.

NPPES Registry Identity

NPI1275622664
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameNORTH BAY DERMATOLOGY ASSOCIATES
Location Address106 LYNCH CREEK WAY, SUITE #8Petaluma, CA 94954-2356
Mailing Address106 Lynch Creek Way, Suite #8Petaluma, CA 94954-2356 · (707) 763-6816 · Fax (707) 763-1730
Phone(707) 763-6816
Fax(707) 763-1730
Organization SubpartNo
Authorized OfficialSantiago CenturionPractice Owner · (707) 763-6816
Enumeration DateOctober 12, 2006
Last NPPES UpdateJune 25, 2019
✔ NPI 1275622664 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
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.
106 LYNCH CREEK WAY, Petaluma, CA 94954
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Other Names 2

Other NameGlenn A. Koby, Md
Doing Business AsNorth Bay Dermatology

Other Identifiers 1

OtherJ5792CA · Railtoad Medicare

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)

Glenn A. Koby, Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Glenn A. Koby, MD, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (2)

Cristina Centurion, NP-C
Nurse Practitioner
NPI 1710053095
3548 US HIGHWAY 9 STE 2
Old Bridge, NJ 08857
(732) 679-6300
✔ PECOS✔ Accepts Medicare2,561 mi
Santiago Centurion, M.D.
Dermatology
NPI 1710099585
3548 US HIGHWAY 9 STE 2
Old Bridge, NJ 08857
(732) 679-6300
✔ PECOS✔ Accepts Medicare2,561 mi

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

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 North Bay Dermatology Associates's NPI number?

The NPI number for North Bay Dermatology Associates is 1275622664. It was assigned to this organization in the NPPES registry on October 12, 2006. The provider is doing business as North Bay Dermatology. The provider is also known as Glenn A. Koby, MD.

Where is North Bay Dermatology Associates located?

North Bay Dermatology Associates is located at 106 Lynch Creek Way Suite #8, Petaluma, CA 94954. The listed phone number is (707) 763-6816.

What is North Bay Dermatology Associates's specialty?

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

Is North Bay Dermatology Associates enrolled in Medicare?

Yes. North Bay Dermatology Associates is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through North Bay Dermatology Associates?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to North Bay Dermatology Associates, in Dermatology and Nurse Practitioner. 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.

When was this NPI record last updated?

The NPPES record for North Bay Dermatology Associates was last updated on June 25, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.