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PENINSULA DERMATOLOGIC SURGERY INC
NPI 1598901340
Dermatology - MOHS-Micrographic Surgery in Menlo Park, CA

Active since December 29, 2008
321 MIDDLEFIELD RD # 245, MENLO PARK, CA 94025(650) 326-7222(650) 326-7332 Get Directions Write a Review

NPPES record last updated: April 10, 2009. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Peninsula Dermatologic Surgery Inc NPPES

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

PENINSULA DERMATOLOGIC SURGERY INC (NPI 1598901340) is a healthcare organization registered as a mohs-micrographic surgery in Menlo Park, California and active in the NPI registry since December 2008. The organization lists Jon C. Starr, Ceo, as its authorized official.

NPPES Registry Identity

NPI1598901340
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NamePENINSULA DERMATOLOGIC SURGERY INC
Location Address321 MIDDLEFIELD RD # 245Menlo Park, CA 94025-3564
Mailing Address321 Middlefield Rd # 245Menlo Park, CA 94025-3564 · (650) 326-7222 · Fax (650) 326-7332
Phone(650) 326-7222
Fax(650) 326-7332
Organization SubpartNo
Authorized OfficialJon C. StarrCeo · (650) 326-7222
Enumeration DateDecember 29, 2008
Last NPPES UpdateApril 10, 2009
✔ NPI 1598901340 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
321 MIDDLEFIELD RD # 245, Menlo Park, CA 94025
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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, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Peninsula Dermatologic Surgery Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20090612000038Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Peninsula Dermatologic Surgery Inc, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Caroline Doo
Dermatology
NPI 1750736898
321 MIDDLEFIELD RD STE 245
Menlo Park, CA 94025
(650) 326-7222
✔ PECOS✔ Accepts MedicareSame address
Tara Miller, MD
Dermatology
NPI 1477685907
321 MIDDLEFIELD RD STE #245
Menlo Park, CA 94025
(650) 326-7222
✔ PECOS✔ Accepts MedicareSame address
Jon Starr, M.D.
Dermatology
NPI 1972612083
321 MIDDLEFIELD RD STE #245
Menlo Park, CA 94025
(650) 326-7222
✔ 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 05D0986243

Peninsula Dermatologic Surgery Inc · Menlo Park, CA
Expired · Sep 30, 2026
CLIA Number05D0986243
Laboratory TypePhysician Office
Certificate Effective DateMay 29, 2024
Certificate Expiration DateSeptember 30, 2026
Laboratory DirectorCaroline Doo
Laboratory Phone(650) 326-7222
Laboratory LocationPeninsula Dermatologic Surgery Inc321 Middlefield Rd Suite 245, Menlo Park, CA 94025
CLIA data matches this NPI record on: 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 Peninsula Dermatologic Surgery Inc's NPI number?

The NPI number for Peninsula Dermatologic Surgery Inc is 1598901340. It was assigned to this organization in the NPPES registry on December 29, 2008.

Where is Peninsula Dermatologic Surgery Inc located?

Peninsula Dermatologic Surgery Inc is located at 321 Middlefield Rd # 245, Menlo Park, CA 94025. The listed phone number is (650) 326-7222.

What is Peninsula Dermatologic Surgery Inc's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Peninsula Dermatologic Surgery Inc enrolled in Medicare?

Yes. Peninsula Dermatologic Surgery Inc is registered in the Medicare PECOS enrollment system.

When is Peninsula Dermatologic Surgery Inc's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Peninsula Dermatologic Surgery Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Dermatology, reassign their Medicare billing to Peninsula Dermatologic Surgery Inc. 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. Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Peninsula Dermatologic Surgery Inc was last updated on April 10, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.