NPIMap

Organization Active NPI

Marin Medical Laboratories

Doing business as Marin General Hospital Path Dept.

  • Anatomic Pathology & Clinical Pathology Physician
  • Greenbrae, CA
National Provider Identifier
1053417386
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
CLF787 Issued in CA
Legal business name
MARIN MEDICAL LABORATORIES
Doing business as
Marin General Hospital Path Dept.
Practice address
250 Bon Air Road
Greenbrae, CA 94904
Phone
(415) 925-7174
Fax
(415) 461-7228
NPI assigned
Sep 15, 2006
Last updated
Aug 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Authorized official

Name
Dr. Paul William Wasserstein, MDNPI 1467560094
Title
Managing Partner
Phone
(415) 925-7174

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X CLF787 CA Primary

Addresses

Primary practice location

250 Bon Air Road
Greenbrae, CA 94904

Mailing address

1615 Hill Rd Ste B
Novato, CA 94947-4338
Phone (415) 898-7649

Other identifiers 1

IdentifierTypeStateIssuer
GR0014390MedicaidCA

Other names 1

  • MARIN GENERAL HOSPITAL PATH DEPT. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000564 CA Part B Supplier - Clinic/Group Practice 7911990916 Receives reassigned benefits from 12 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eureka, CA; Greenbrae, CA; Santa Rosa, CA; Sonoma, CA

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Marin Medical Lab6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1053417386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 HILL RD STE B",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949474338",
            "telephone_number": "415-898-7649",
            "fax_number": "415-898-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BON AIR ROAD",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "94904",
            "telephone_number": "415-925-7174",
            "fax_number": "415-461-7228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN MEDICAL LABORATORIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "WASSERSTEIN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "415-925-7174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "CLF787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0014390",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIN GENERAL HOSPITAL PATH DEPT.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.