NPIMap

Organization Active NPI

Marin Medical Laboratories

  • Anatomic Pathology & Clinical Pathology Physician
  • Santa Rosa, CA
National Provider Identifier
1326444647
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
CLF 00001292 Issued in CA
Legal business name
MARIN MEDICAL LABORATORIES
Practice address
1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone
(707) 525-5352
Fax
(707) 522-1535
NPI assigned
Nov 13, 2014
Last updated
Aug 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Authorized official

Name
Dr. Kedar Che Prasad, MDNPI 1841308558
Title
Pathologist
Phone
(415) 209-6983

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X CLF 00001292 CA Primary

Addresses

Primary practice location

1165 Montgomery Dr
Santa Rosa, CA 95405-4801

Mailing address

1615 Hill Rd Ste B
Novato, CA 94947-4338
Phone (415) 898-7649

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000564 CA Part B Supplier - Clinic/Group Practice 7911990916 Receives reassigned benefits from 12 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eureka, CA; Greenbrae, CA; Santa Rosa, CA; Sonoma, CA

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Marin Medical Laboritor6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1415836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1326444647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 HILL RD STE B",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949474338",
            "telephone_number": "415-898-7649",
            "fax_number": "415-898-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054801",
            "telephone_number": "707-525-5352",
            "fax_number": "707-522-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN MEDICAL LABORATORIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-13",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "PRASAD",
        "authorized_official_first_name": "KEDAR",
        "authorized_official_middle_name": "CHE",
        "authorized_official_title_or_position": "PATHOLOGIST",
        "authorized_official_telephone_number": "415-209-6983",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "CLF 00001292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.