NPIMap

Organization Active NPI

Marin Medical Laboratories

  • Anatomic Pathology & Clinical Pathology Physician
  • Eureka, CA
National Provider Identifier
1356061477
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
MARIN MEDICAL LABORATORIES
Practice address
2700 Dolbeer St
Eureka, CA 95501-4736
Phone
(707) 445-8121
Fax
(415) 898-0870
NPI assigned
Aug 30, 2022
Organization subpart
Yes
Parent organization
MARIN MEDICAL LABORATORIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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/Partner
Phone
(415) 925-7174

Specialties & licenses 1

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

Addresses

Primary practice location

2700 Dolbeer St
Eureka, CA 95501-4736

Mailing address

1615 Hill Rd Ste B
Novato, CA 94947-4338
Phone (415) 209-6983

Other practice location 1

2200 Harrison Ave
Eureka, CA 95501-3215
Phone (707) 445-8121 ext. 6613

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
Part of
Marin Med Labs

Other organizations with this tax ID 5

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

Locations

1300 S Eliseo Dr
Ste 102
Greenbrae, CA 94904
Phone (415) 925-6967

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1661817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1356061477",
    "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": "415-209-6983",
            "fax_number": "415-898-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 DOLBEER ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955014736",
            "telephone_number": "707-445-8121",
            "fax_number": "415-898-0870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Harrison Ave",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955013215",
            "country_code": "US",
            "telephone_number": "707-445-8121 x6613",
            "fax_number": "415-898-0870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARIN MEDICAL LABORATORIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIN MEDICAL LABORATORIES",
        "enumeration_date": "2022-08-30",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "PRASAD",
        "authorized_official_first_name": "KEDAR",
        "authorized_official_middle_name": "CHE",
        "authorized_official_title_or_position": "PATHOLOGIST/PARTNER",
        "authorized_official_telephone_number": "415-925-7174",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.