NPIMap

Organization Active NPI

Prima Medical Foundation

  • Pediatrics Physician
  • Greenbrae, CA
National Provider Identifier
1396909735
Registry record updated Jul 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A42149 Issued in CA
Legal business name
PRIMA MEDICAL FOUNDATION
Practice address
1260 S. Eliseo Dr
Floor 2
Greenbrae, CA 94904-2009
Phone
(415) 924-1214
NPI assigned
Jul 15, 2008
Organization subpart
Yes
Parent organization
PRIMA MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2015

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

Authorized official

Name
Joanna Rubel
Title
Sr. Director of Practice Operations
Phone
(415) 842-5103

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X G55637 CA
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A42149 CA Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X A65187 CA

Addresses

Primary practice location

1260 S. Eliseo Dr
Floor 2
Greenbrae, CA 94904-2009

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ03538ZOtherCAMEDICARE PTAN

Other names 1

  • Urgent Care Pediatric After Hours Other name

National Provider Directory

National Provider Directory
Tax ID family
Prima Medical Foundation19 organizations share this tax ID, including this one
Part of
Prima Medical Foundation

Other organizations with this tax ID 18

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

View all 18

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": "1437177600000",
    "number": "1396909735",
    "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": "1260 S. ELISEO DR",
            "address_2": "FLOOR 2",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042009",
            "telephone_number": "415-924-1214"
        }
    ],
    "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": "2015-07-18",
        "status": "A",
        "authorized_official_last_name": "RUBEL",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "SR. DIRECTOR OF PRACTICE OPERATIONS",
        "authorized_official_telephone_number": "415-842-5103"
    },
    "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A42149",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A65187",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "ZZZ03538Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Urgent Care Pediatric After Hours",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2015; 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.