NPIMap

Organization Active NPI

Prima Medical Foundation Sebastopol

  • Multi-Specialty Clinic/Center
  • Sebastopol, CA
National Provider Identifier
1154590958
Registry record updated Apr 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PRIMA MEDICAL FOUNDATION SEBASTOPOL
Practice address
652 Petaluma Ave
Suite H
Sebastopol, CA 95472-4256
Phone
(707) 823-7616
Fax
(707) 823-2803
NPI assigned
Feb 26, 2008
Organization subpart
Yes
Parent organization
PRIMA MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2013

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

Authorized official

Name
Dennis Mondragon
Title
Coo
Phone
(415) 884-1840

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

652 Petaluma Ave
Suite H
Sebastopol, CA 95472-4256

Mailing address

4 Hamilton LNDG Ste 100
Novato, CA 94949-8247
Phone (415) 884-1840

Other names 1

  • Prima Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prima Medical Foundation19 organizations share this tax ID, including this one
Part of
Prima Medical Foundation

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366761600000",
    "number": "1154590958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HAMILTON LNDG STE 100",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949498247",
            "telephone_number": "415-884-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 PETALUMA AVE",
            "address_2": "SUITE H",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724256",
            "telephone_number": "707-823-7616",
            "fax_number": "707-823-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMA MEDICAL FOUNDATION SEBASTOPOL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMA MEDICAL FOUNDATION",
        "enumeration_date": "2008-02-26",
        "last_updated": "2013-04-24",
        "status": "A",
        "authorized_official_last_name": "MONDRAGON",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "415-884-1840"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prima Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sebastopol, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.