NPIMap

Organization Active NPI

Marin Medical Laboratories

  • Anatomic Pathology & Clinical Pathology Physician
  • Sonoma, CA
National Provider Identifier
1346532314
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 1363 Issued in CA
Legal business name
MARIN MEDICAL LABORATORIES
Practice address
347 Andrieux St
Sonoma, CA 95476-6811
Phone
(707) 935-5185
Fax
(707) 935-5437
NPI assigned
May 10, 2011
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, MD
Title
Pathologist
Phone
(415) 209-6017

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X CLF 1363 CA Primary

Addresses

Primary practice location

347 Andrieux St
Sonoma, CA 95476-6811

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 Med Labs6 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 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1346532314",
    "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": "347 ANDRIEUX ST",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954766811",
            "telephone_number": "707-935-5185",
            "fax_number": "707-935-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN MEDICAL LABORATORIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "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": "415-209-6017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "CLF 1363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonoma, 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.