Individual provider Active NPI

Marissa Castro Fernandez Kiemele, MD

  • Family Medicine Physician
  • San Rafael, CA
National Provider Identifier
1144297516
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C192860 Issued in CA
Practice address
4000 Civic Center Dr Ste 200B
San Rafael, CA 94903-5232
Phone
(415) 492-3333
Fax
(415) 492-3425
NPI assigned
Mar 3, 2006
Last updated
Jul 1, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 292453 MA
Family Medicine Physician 207Q00000X 18726 NH
Family Medicine Physician 207Q00000X C192860 CA Primary

Addresses

Primary practice location

4000 Civic Center Dr Ste 200B
San Rafael, CA 94903-5232

Mailing address

4000 Civic Center Dr Ste 200B
San Rafael, CA 94903-5232
Phone (415) 492-3333

Other names 1

  • Dr. Marissa Castro Fernandez Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230605001900 MA Practitioner - Family Practice 0547212300 Reassigns benefits to 2 organizations
I20260521000769 CA Practitioner - Family Practice 0547212300 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2001 The Embarcadero
San Francisco, CA 94143-5200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C192860CAMDFamily Medicine Physician
292453MAMDFamily Medicine Physician
18726NHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The General Hospital Corporation CurrentSince Mar 18, 2024 Accepting new patients
Massachusetts General Physicians Organization Inc CurrentSince Mar 18, 2024 Accepting new patients
Camp Verde Family Health LLC Past Accepting new patients

Locations

50 Staniford St
Fl 9
Boston, MA 02114
Phone (617) 724-6610

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1144297516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 CIVIC CENTER DR STE 200B",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949035232",
            "telephone_number": "415-492-3333",
            "fax_number": "415-492-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 CIVIC CENTER DR STE 200B",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949035232",
            "telephone_number": "415-492-3333",
            "fax_number": "415-492-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ KIEMELE",
        "first_name": "MARISSA",
        "middle_name": "CASTRO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-03",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "292453",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "18726",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C192860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "FERNANDEZ",
            "middle_name": "CASTRO",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.