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KEITH MARK GROSS MD INC
NPI 1871658278
Dermatology in Victorville, CA

Active since December 26, 2006
15247 11TH ST, SUITE 400, VICTORVILLE, CA 92395(909) 335-8638(909) 335-8644 Get Directions Write a Review

NPPES record last updated: January 17, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Keith Mark Gross Md Inc NPPES

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

KEITH MARK GROSS MD INC (NPI 1871658278) is a healthcare organization registered as a dermatology in Victorville, California and active in the NPI registry since December 2006. The organization lists Keith Gross, Owner, as its authorized official.

NPPES Registry Identity

NPI1871658278
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameKEITH MARK GROSS MD INC
Location Address15247 11TH ST, SUITE 400Victorville, CA 92395-3727
Mailing AddressPo Box 51197, Dept 1401Los Angeles, CA 90051-5497
Phone(909) 335-8638
Fax(909) 335-8644
Organization SubpartNo
Authorized OfficialKeith GrossOwner · (909) 335-8638
Enumeration DateDecember 26, 2006
Last NPPES UpdateJanuary 17, 2008
✔ NPI 1871658278 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in CA · G63544
Definition
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.
15247 11TH ST, Victorville, CA 92395
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Other Identifiers 7

Medicare ID-Type Unspecified00G635440CA
Medicare ID-Type Unspecified00G635449CA
Medicare ID-Type Unspecified00G635446CA
Medicare ID-Type Unspecified00G635444CA
Medicare ID-Type Unspecified00G635448CA
Medicare ID-Type UnspecifiedV32038NV
Medicare ID-Type Unspecified00G635442CA

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)

Keith Mark Gross Md Inc 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 Keith Mark Gross MD Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Keith Gross, MD
Dermatology
NPI 1952357188
12550 HESPERIA RD 400
Victorville, CA 92395
(909) 335-8638
✔ PECOS✔ Accepts Medicare3.4 mi

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 05D0896408

Keith Mark Gross MD Inc · Victorville, CA
Expired · Sep 30, 2026
CLIA Number05D0896408
Laboratory TypePhysician Office
Certificate Effective DateSeptember 16, 2024
Certificate Expiration DateSeptember 30, 2026
Laboratory DirectorDr. Keith M. Gross
Laboratory Phone(760) 951-9895
Laboratory LocationKeith Mark Gross MD Inc12550 Hesperia Rd, Ste 218, Victorville, CA 92395
CLIA data matches this NPI record on: Name
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 Keith Mark Gross MD Inc's NPI number?

The NPI number for Keith Mark Gross MD Inc is 1871658278. It was assigned to this organization in the NPPES registry on December 26, 2006.

Where is Keith Mark Gross MD Inc located?

Keith Mark Gross MD Inc is located at 15247 11th St Suite 400, Victorville, CA 92395. The listed phone number is (909) 335-8638.

What is Keith Mark Gross MD Inc's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Keith Mark Gross MD Inc enrolled in Medicare?

Yes. Keith Mark Gross MD Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Keith Mark Gross MD Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Keith Mark Gross MD 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Keith Mark Gross MD Inc was last updated on January 17, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.