Novato Dermatology Associates a Medical Corporation

Public-record details

Address

867 Diablo Ave, Novato, CA 94947

Phone

(415) 892-0754

Listed under

Practices and organizations

NPI

1003960063

NPI status

Active in the NPPES registry

Provider type

Organization (practice, clinic or company)

Registered specialty (self-reported taxonomy)

Dermatology (207N00000X)

License number on NPI record

G79619 (CA)

Authorized official

Kim Frederickson, MD, Owner

NPI first issued

Jan 23, 2007

Years since NPI first issued

19 years (since 2007)

License state on NPI record

CA

NPI record last updated

Nov 8, 2018

Medicare group enrollment (CMS)

Enrolled: listed in CMS Doctors & Clinicians as Novato Dermatology Associates a Medical Corporation

Clinicians in the Medicare group (all specialties, CMS)

2

Dermatology clinicians in the group at this ZIP (CMS)

2

Group Medicare assignment (CMS)

Accepts the Medicare-approved amount as payment in full

NPI 1003960063 is active in the federal NPPES registry (CMS) with Dermatology as its self-reported primary taxonomy; license G79619 (CA) is listed on the record. CMS Doctors & Clinicians lists a Medicare-enrolled group with this name at this ZIP. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-10-16.

Public record, not an endorsement. This listing was compiled from public records as of 2026-10-16 and may be incomplete or out of date. Dermatologist Index does not vet, employ, recommend or guarantee dermatology practices; a badge reflects only what the public record showed on that date. Confirm current details with the official record before you decide. The information on Dermatologist Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Full disclaimer · Report an error

What these registry facts mean

The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an organization, so it may cover several clinicians at this location. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. A registered specialty is not board certification. To check board certification, use the American Board of Dermatology's verification tool (or the American Osteopathic Board of Dermatology for DOs), and confirm the medical license with the state board.

View NPI 1003960063 in the official registry ↗