NPIMap

Organization Active NPI

Prima Medical Foundation

  • Pediatrics Physician
  • Mill Valley, CA
National Provider Identifier
1366606766
Registry record updated Aug 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A77821 Issued in CA
Legal business name
PRIMA MEDICAL FOUNDATION
Practice address
655 Redwood Highway
Suite 216
Mill Valley, CA 94941
Phone
(415) 383-3500
Fax
(415) 383-3554
NPI assigned
Jul 15, 2008
Last updated
Aug 31, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMA MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2012

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

Authorized official

Name
Mr. Joel A. Criste
Title
Ceo
Phone
(415) 884-1840

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X G55637 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A77821 CA Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X A65187 CA
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

655 Redwood Highway
Suite 216
Mill Valley, CA 94941

Mailing address

4 Hamilton Landing
Suite 100
Novato, CA 94949
Phone (415) 884-1840

National Provider Directory

National Provider Directory
Tax ID family
Prima Medical Group-Terra Linda19 organizations share this tax ID, including this one
Part of
Prima Medical Group-Terra Linda

Other organizations with this tax ID 18

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

View all 18

Locations

4 Hamilton Landing
Ste 100
Novato, CA 94949
Phone (415) 884-1840

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346371200000",
    "number": "1366606766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HAMILTON LANDING",
            "address_2": "SUITE 100",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94949",
            "telephone_number": "415-884-1840",
            "fax_number": "415-884-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 REDWOOD HIGHWAY",
            "address_2": "SUITE 216",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-383-3500",
            "fax_number": "415-383-3554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMA MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMA MEDICAL FOUNDATION",
        "enumeration_date": "2008-07-15",
        "last_updated": "2012-08-31",
        "status": "A",
        "authorized_official_last_name": "CRISTE",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-884-1840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G55637",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A77821",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A65187",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.