NPIMap

Organization Active NPI

Marin Healthcare District

  • Family Medicine Physician
  • Point Reyes Station, CA
National Provider Identifier
1174896799
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARIN HEALTHCARE DISTRICT
Practice address
11150 Highway 1
Point Reyes Station, CA 94956-9756
Phone
(415) 663-1082
Fax
(415) 663-9474
NPI assigned
Feb 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2013

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

Authorized official

Name
Lee Domanico
Title
Ceo
Phone
(415) 464-2090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11150 Highway 1
Point Reyes Station, CA 94956-9756

Mailing address

PO Box 45094
San Francisco, CA 94145-0094
Phone (415) 464-2090

Other identifiers 1

IdentifierTypeStateIssuer
CS440AOtherCAMEDICARE GROUP PTAN

Other names 1

  • West Marin Medical Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Colin Hamblin a Professional Medical Corporation13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1329091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383177600000",
    "number": "1174896799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45094",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941450094",
            "telephone_number": "415-464-2090",
            "fax_number": "415-464-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11150 HIGHWAY 1",
            "city": "POINT REYES STATION",
            "state": "CA",
            "postal_code": "949569756",
            "telephone_number": "415-663-1082",
            "fax_number": "415-663-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-13",
        "last_updated": "2013-10-31",
        "status": "A",
        "authorized_official_last_name": "DOMANICO",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-464-2090"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "CS440A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Marin Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Point Reyes Station, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.