NPIMap

Organization Active NPI

Marin City Health and Wellness Center

Doing business as Perinatal and Women's Health Suite

  • Federally Qualified Health Center (FQHC)
  • Sausalito, CA
National Provider Identifier
1285804948
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARIN CITY HEALTH AND WELLNESS CENTER
Doing business as
Marin City Health and Wellness Center
Perinatal and Women's Health Suite
Practice address
630 Drake Ave
Sausalito, CA 94965-1107
Phone
(415) 339-8813
Fax
(415) 339-8814
NPI assigned
Mar 8, 2008
Last updated
Oct 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2021

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

Authorized official

Name
Adam Crawford FrancisNPI 1801186648
Title
Cmo
Phone
(415) 339-8813

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Community/Behavioral Health Agency 251S00000X CA

Addresses

Primary practice location

630 Drake Ave
Sausalito, CA 94965-1107

Mailing address

630 Drake Avenue
Sausalito, CA 94965-1107
Phone (415) 339-8813

Other practice location 1

6301 3rd St
San Francisco, CA 94124-3501
Phone (415) 339-8813

Other practice location 2

880 Las Gallinas Ave Ste 2
San Rafael, CA 94903-3437
Phone (415) 339-8813

Other names 2

  • Marin City Health and Wellness Center Doing business as
  • Perinatal and Women's Health Suite Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091221000011 CA Part B Supplier - Clinic/Group Practice 1052451259 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
Practice locations: Sausalito, CA; San Rafael, CA; San Francisco, CA
O20120326000510 CA Part A Provider - Federally Qualified Health Center (FQHC) 1052451259 Practice locations: Sausalito, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285804948. Details of each certification follow.

Federally qualified health center certification: CCN 551117

Legal name
MARIN CITY HEALTH AND WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 2011
Last certification
Aug 1, 2011
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Apr 25, 2006 in CA
Enrollment address
630 Drake Ave
Sausalito, CA 94965-1107

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Marin City Health Wellness3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Adam C Francis Individual Corporate OfficerCmo Aug 1, 2020
Nichole Henderson Individual W-2 Managing EmployeeBilling Manager Sep 20, 2021 100%
Patrick H Lee Individual Corporate DirectorBoard Member May 26, 2015 100%
Diane Kamai Individual W-2 Managing EmployeeFinana Administrative Coordinato Nov 30, 2016 100%

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 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1204934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1285804948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 DRAKE AVENUE",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651107",
            "telephone_number": "415-339-8813",
            "fax_number": "415-339-8814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 DRAKE AVE",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651107",
            "telephone_number": "415-339-8813",
            "fax_number": "415-339-8814"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6301 3rd St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941243501",
            "country_code": "US",
            "telephone_number": "415-339-8813",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "880 Las Gallinas Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "San Rafael",
            "state": "CA",
            "postal_code": "949033437",
            "country_code": "US",
            "telephone_number": "415-339-8813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARIN CITY HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-08",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "FRANCIS",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "CRAWFORD",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "415-339-8813"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marin City Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Perinatal and Women's Health Suite",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sausalito, CA

Sources for this page

Verify at the official NPI Registry.