NPIMap

Organization Active NPI

Peter J Marincovich

  • Audiologist
  • Santa Rosa, CA
National Provider Identifier
1417044801
Registry record updated Mar 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AU758 Issued in CA
Legal business name
PETER J MARINCOVICH
Practice address
1111 Sonoma Ave
Suite 316
Santa Rosa, CA 95405-4819
Phone
(707) 523-4740
Fax
(707) 523-0231
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2013

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

Authorized official

Name
Peter Jansen Marincovich, PHD AUDIOLOGIST DISPNPI 1447327507
Title
Owner Audiologist
Phone
(707) 523-4740

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X AU758 CA Primary
Audiologist-Hearing Aid FitterGroup: 193200000X MULTI-SPECIALTY GROUP 237600000X HA1949 CA

Addresses

Primary practice location

1111 Sonoma Ave
Suite 316
Santa Rosa, CA 95405-4819

Mailing address

1111 Sonoma Ave
Suite 316
Santa Rosa, CA 95405-4819
Phone (707) 523-4740

Other identifiers 4

IdentifierTypeStateIssuer
640002077OtherCARRM
ZZZ03361ZOtherCABLUE SHIELD
AU0007580MedicaidCA
ZZZ03362ZOtherCABLUE SHIELD

Other names 1

  • Audiology Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Audiology Associates4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363132800000",
    "number": "1417044801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 SONOMA AVE",
            "address_2": "SUITE 316",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054819",
            "telephone_number": "707-523-4740",
            "fax_number": "707-523-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 SONOMA AVE",
            "address_2": "SUITE 316",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054819",
            "telephone_number": "707-523-4740",
            "fax_number": "707-523-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER J MARINCOVICH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2013-03-13",
        "status": "A",
        "authorized_official_last_name": "MARINCOVICH",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "JANSEN",
        "authorized_official_title_or_position": "OWNER AUDIOLOGIST",
        "authorized_official_telephone_number": "707-523-4740",
        "authorized_official_credential": "PHD AUDIOLOGIST DISP"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU758",
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "CA",
            "license": "HA1949",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRM",
            "identifier": "640002077",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ03361Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AU0007580",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ03362Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Audiology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 13, 2013; 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.