NPIMap

Organization Active NPI

Marin Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Novato, CA
National Provider Identifier
1003900101
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
110000491 Issued in CA
Legal business name
MARIN COMMUNITY CLINIC
Practice address
6100 Redwood Blvd
Novato, CA 94945-4505
Phone
(415) 448-1500
Fax
(415) 798-3198
NPI assigned
Oct 3, 2006
Last updated
Jun 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brenda Shipp
Title
Chief Executive Officer
Phone
(415) 475-4572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 110000491 CA Primary

Addresses

Primary practice location

6100 Redwood Blvd
Novato, CA 94945-4505

Mailing address

9 Commercial Blvd
Suite 103
Novato, CA 94949-6118
Phone (415) 448-1500

Other identifiers 1

IdentifierTypeStateIssuer
FHC70941MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021207000005 CA Part A Provider - Federally Qualified Health Center (FQHC) 0840108031 Practice locations: Novato, CA
O20250611003402 CA Part B Supplier - Clinic/Group Practice 0840108031 Receives reassigned benefits from 15 practitioners
5 other NPIs on this enrollment
Practice locations: San Rafael, CA; Novato, CA; Greenbrae, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003900101. Details of each certification follow.

Federally qualified health center certification: CCN 551918

Legal name
MARIN COMMUNITY CLINIC
Doing business as
MARIN COMMUNITY CLINICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 29, 2003
Last certification
Jan 29, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1974 in CA
Enrollment address
6100 Redwood Blvd
Novato, CA 94945-4501

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1002008Marin Community Clinic - Novato6100 Redwood Blvd, Novato, CA 94945Provider-performed microscopyJul 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Marin Community Clinic16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

9 Commercial Blvd
#103
Novato, CA 94949

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Edward Murphy Individual W-2 Managing Employee Mar 1, 2011
Carlos Garcia-Bedoya Individual Corporate Director Jul 22, 2009
William Kerr Individual Corporate Director Jul 22, 2009
Freshte Kashani Individual Corporate Director Jul 22, 2009
Michael Harris Individual Corporate Director Jul 1, 2011
Martin Sleath Individual Corporate Director Jul 22, 2009
Farhan Fadoo Individual Corporate OfficerCeo Dec 1, 2023
Susan Mace Individual Corporate Director Jul 22, 2009

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750982400000",
    "number": "1003900101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 COMMERCIAL BLVD",
            "address_2": "SUITE 103",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496118",
            "telephone_number": "415-448-1500",
            "fax_number": "415-798-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 REDWOOD BLVD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454505",
            "telephone_number": "415-448-1500",
            "fax_number": "415-798-3198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A",
        "authorized_official_last_name": "SHIPP",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "415-475-4572"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "110000491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70941",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

Verify at the official NPI Registry.