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NORCAL DERMATOLOGY MEDICAL SURGICAL COSMETIC
NPI 1881839520
Clinic/Center - Medical Specialty in Santa Rosa, CA

Active since December 10, 2008CLIA 05D2033588 · Certificate of Compliance
196 WIKIUP DR, SANTA ROSA, CA 95403(707) 527-9517(707) 527-9913 Get Directions Write a Review

NPPES record last updated: November 22, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 22, 2022, Apr 29, 2021, Jul 31, 2017 (3 updates tracked since 2017).

About Norcal Dermatology Medical Surgical Cosmetic NPPES

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

NORCAL DERMATOLOGY MEDICAL SURGICAL COSMETIC (NPI 1881839520) is a healthcare organization registered as a medical specialty in Santa Rosa, California and active in the NPI registry since December 2008. The organization holds a CLIA Certificate of Compliance certificate valid through July 6, 2028 and lists Alicia Brophy, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1881839520
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameNORCAL SKIN DISEASE AND SURGERY INC
Location Address196 WIKIUP DRSanta Rosa, CA 95403-7773
Mailing Address196 Wikiup DrSanta Rosa, CA 95403-7773 · (707) 527-9517 · Fax (707) 527-9913
Phone(707) 527-9517
Fax(707) 527-9913
Organization SubpartNo
Authorized OfficialAlicia BrophyPractice Manager · (707) 527-9517
Enumeration DateDecember 10, 2008
Last NPPES UpdateNovember 22, 20223 updates tracked since enumeration
NPPES CertifiedNovember 22, 2022
✔ NPI 1881839520 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in CA · A55665
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
196 WIKIUP DR, Santa Rosa, CA 95403
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Other Names 1

Doing Business AsNorcal Dermatology Medical Surgical Cosmetic

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Norcal Dermatology Medical Surgical Cosmetic 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 Norcal Dermatology Medical Surgical Cosmetic, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Henry Degroot, MD
Dermatology
NPI 1346260411
196 WIKIUP DR
Santa Rosa, CA 95403
(707) 527-9517
✔ PECOS✔ Accepts MedicareSame address
Khanh Truong, M.D.
Dermatology
NPI 1619962552
196 WIKIUP DR
Santa Rosa, CA 95403
(075) 279-5177
✔ 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 05D2033588

Norcal Skin Disease And Surgery, Inc · Santa Rosa, CA
Active · expires Jul 6, 2028
CLIA Number05D2033588
Laboratory TypePhysician Office
Certificate Effective DateJuly 7, 2026
Certificate Expiration DateJuly 6, 2028
Laboratory DirectorDr. Khanh Y. Truong MD
Laboratory Phone(707) 527-9517
Laboratory LocationNorcal Skin Disease And Surgery, Inc196 Wikiup Dr, Santa Rosa, CA 95403
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 Norcal Skin Disease And Surgery Inc's NPI number?

The NPI number for Norcal Skin Disease And Surgery Inc is 1881839520. It was assigned to this organization in the NPPES registry on December 10, 2008. The provider is doing business as Norcal Dermatology Medical Surgical Cosmetic.

Where is Norcal Skin Disease And Surgery Inc located?

Norcal Skin Disease And Surgery Inc is located at 196 Wikiup Dr, Santa Rosa, CA 95403. The listed phone number is (707) 527-9517.

What is Norcal Skin Disease And Surgery Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Is Norcal Skin Disease And Surgery Inc enrolled in Medicare?

Yes. Norcal Skin Disease And Surgery Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Norcal Skin Disease And Surgery Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Norcal Skin Disease And 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Norcal Skin Disease And Surgery Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D2033588) is associated with this NPI, valid through July 6, 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 Norcal Skin Disease And Surgery Inc was last updated on November 22, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.