NPIMap

Organization Active NPI

Marin City Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • San Rafael, CA
National Provider Identifier
1457888299
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
55000861 Issued in CA
Legal business name
MARIN CITY HEALTH AND WELLNESS CENTER
Practice address
880 Las Gallinas Ave
Suite 2
San Rafael, CA 94903
Phone
(415) 339-8813
NPI assigned
May 11, 2017
Last updated
Jul 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Authorized official

Name
Jayvon Muhammad
Title
Chief Executive Officer
Phone
(415) 339-8813

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 55000861 CA Primary

Addresses

Primary practice location

880 Las Gallinas Ave
Suite 2
San Rafael, CA 94903

Mailing address

630 Drake Ave
Sausalito, CA 94965-1107
Phone (415) 339-8813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091221000011 CA Part B Supplier - Clinic/Group Practice 1052451259 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sausalito, CA; San Rafael, CA; San Francisco, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1457888299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 DRAKE AVE",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949651107",
            "telephone_number": "415-339-8813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 LAS GALLINAS AVE",
            "address_2": "SUITE 2",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-339-8813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN CITY HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2018-07-11",
        "status": "A",
        "authorized_official_last_name": "MUHAMMAD",
        "authorized_official_first_name": "JAYVON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "415-339-8813"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "55000861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.