Unknown Individual – Clinical & Laboratory Dermatological Immunology Physician, NPI 1740371269
Clinical & Laboratory Dermatological Immunology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1225, Crane Street, Menlo Park, San Mateo County, California, 94025, United States
SUITE 102
MENLO PARK, CA 94025
Phone: (650) 323-0276
Fax: (650) 323-8540
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $19.
Total Amount is formed as General ($19) + Research ($0) + Ownership ($0) = $19.
Last reported payment date: 2024-12-20 • Largest payer in this snapshot: REVANCE THERAPEUTICS, INC. ($19).
Total Amount
$19
General + Research + Ownership
Payments
1
Total payment records
General Amount
$19
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| REVANCE THERAPEUTICS, INC. | $19 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 271 | 83 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 268 | 224 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 158 | 135 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 118 | 98 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 71 | 66 | $0 |
Insurance plans in this area (ZIP 94025)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | CA | 17003 | Destruction of 2-14 skin growths | 1153 | 297 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | CA | |
| D E R M A T O L O G Y | TN | |
| D E R M A T O L O G Y | MD |
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