Individual provider Active NPI

Doreen Telisak Marino, M.D.

  • Internal Medicine Physician
  • Aurora, CO
National Provider Identifier
1295934081
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
45811 Issued in CO
Practice address
1400 S Potomac St
Suite 110
Aurora, CO 80012-4528
Phone
(303) 745-0000
Fax
(303) 745-1299
NPI assigned
Jul 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X A113085 CA
Internal Medicine Physician 207R00000X 45811 CO Primary

Addresses

Primary practice location

1400 S Potomac St
Suite 110
Aurora, CO 80012-4528

Mailing address

1400 S Potomac St
Suite 110
Aurora, CO 80012-4528
Phone (303) 745-0000

Other practice location 1

400 N McDowell Blvd
Petaluma, CA 94954-2339
Phone (707) 303-1709

Other names 1

  • Doreen Ann Telisak Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110622000629 CA Practitioner - HospitalistPractitioner - Internal Medicine 9436241544 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

400 N McDowell Blvd
Petaluma, CA 94954-2339
Phone (707) 778-2631

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
113085CAMDMarriage & Family Therapist
45811COMDInternal Medicine Physician
A113085CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents Univ of California UCSF Internal Medicine CurrentSince Nov 1, 2018 Accepting new patients
Prima Medical Foundation CurrentSince Dec 1, 2016 Accepting new patients
Vituity Hospitalists PC Internal Medicine CurrentSince Nov 1, 2022 Accepting new patients
Providence Medical Foundation CurrentSince Oct 1, 2022 Accepting new patients
Vituity Hospitalists PC Internal Medicine Current Accepting new patients
Providence Medical Foundation Internal Medicine CurrentSince Oct 1, 2022 Accepting new patients
Vituity Hospitalists PC Internal Medicine CurrentSince Nov 1, 2022 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Sonoma Valley Health Care District Past Accepting new patients
Critical Care & Pulmonary Consultants, PC Hospitalist PastSince Jul 1, 2002 Accepting new patients
Philippe G Lopez MD PC PastSince Jun 16, 2024 Accepting new patients
Barton Healthcare System Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
SRM Alliance Hospital Services Past Accepting new patients
Portercare Adventist Health System Past Accepting new patients
HCA-Healthone LLC Past Accepting new patients
Providence Medical Foundation Past Accepting new patients
HCA Healthone LLC Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1260 S Eliseo Dr
Fl 2
Greenbrae, CA 94904
Phone (415) 464-1350

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

400 N McDowell Blvd
Petaluma, CA 94954
Phone (707) 778-1111

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

900 Hyde St
San Francisco, CA 94109
Phone (415) 353-6000

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

651 1st St W
Ste H
Sonoma, CA 95476
Phone (707) 938-3870

Organizations & group practices 18

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

View all 18

Hospital & facility affiliations 4

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": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1295934081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S POTOMAC ST",
            "address_2": "SUITE 110",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124528",
            "telephone_number": "303-745-0000",
            "fax_number": "303-745-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S POTOMAC ST",
            "address_2": "SUITE 110",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124528",
            "telephone_number": "303-745-0000",
            "fax_number": "303-745-1299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N McDowell Blvd",
            "address_purpose": "LOCATION",
            "city": "Petaluma",
            "state": "CA",
            "postal_code": "949542339",
            "country_code": "US",
            "telephone_number": "707-303-1709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARINO",
        "first_name": "DOREEN",
        "middle_name": "TELISAK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-12",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A113085",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "45811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOREEN",
            "last_name": "TELISAK",
            "middle_name": "ANN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.