Medderm Corporation

Public-record details

Address

3965 5th Ave Ste 200, San Diego, CA 92103

Phone

(619) 542-0013

Listed under

Practices and organizations, Telehealth (Medicare claims)

NPI

1063447936

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

A88009 (CA)

Authorized official

Michelle Pelle, MD, Owner/director

NPI first issued

Jul 11, 2006

Years since NPI first issued

20 years (since 2006)

License state on NPI record

CA

NPI record last updated

Apr 18, 2023

Medicare group enrollment (CMS)

Enrolled: listed in CMS Doctors & Clinicians as Medderm Corporation

Clinicians in the Medicare group (all specialties, CMS)

7

Dermatology clinicians in the group at this ZIP (CMS)

5

Group Medicare assignment (CMS)

Accepts the Medicare-approved amount as payment in full

Other dermatology listings at this street address

2

NPI 1063447936 is active in the federal NPPES registry (CMS) with Dermatology as its self-reported primary taxonomy; license A88009 (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 This listing was compiled from public records as of 2026-10-16 and may be incomplete or out of date.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 1063447936 in the official registry ↗

Dermatology clinicians and practices at this address

Other listings in this directory whose NPI record gives the same street address and ZIP. A shared address usually means a shared practice or building; it does not by itself show who works with whom.

• Michelle Pelle, MD
• Michael Lee, MD