DALE A KOOISTRA (M.D., PHD.) – Dermatology Physician, NPI 1831182971
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,140 DERMATOLOGY in CA
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Provider Addresses for DALE A KOOISTRA (M.D., PHD.)
15525, Pomerado Road, Poway, San Diego County, California, 92128, United States
SUITE D2
POWAY, CA 920642435
Phone: (858) 675-8001
Fax: (858) 487-1337
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 87 Open Payments records for all available years, with a total value of $1,855.
Total Amount is formed as General ($1,855) + Research ($0) + Ownership ($0) = $1,855.
Last reported payment date: 2024-12-17 • Largest payer in this snapshot: E.R. Squibb & Sons, L.L.C. ($494).
Total Amount
$1,855
General + Research + Ownership
Payments
87
Total payment records
General Amount
$1,855
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-17
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-10-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20101029000319 | I | Dermatology | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
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 | 870 | 141 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 295 | 203 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 244 | 175 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 175 | 139 | $0 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 65 | 17 | $0 |
Insurance plans in this area (ZIP 92064)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | MO |
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