Organization Active NPI

Southern Marin Dermatology, Inc.

  • Dermatology Physician
  • Sausalito, CA
National Provider Identifier
1487090924
Registry record updated May 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SOUTHERN MARIN DERMATOLOGY, INC.
Practice address
2330 Marinship Way
Suite 370
Sausalito, CA 94965-2853
Phone
(415) 887-9758
Fax
(415) 887-9763
NPI assigned
May 10, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Ashley A Smith, M.D.NPI 1053579979
Title
President
Phone
(415) 887-9758

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2075709Southern Marin Dermatology Inc2330 Marinship Way, Ste 370, Sausalito, CA 94965ComplianceOct 19, 2026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130807000186 CA Part B Supplier - Clinic/Group Practice 2668614447 Receives reassigned benefits from 10 practitioners
Practice locations: Sausalito, CA

National Provider Directory

National Provider Directory

Locations

2330 Marinship Way
Ste 370
Sausalito, CA 94965
Phone (415) 887-2853

2330 Marinship Way
Sausalito, CA 94965

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

2330 Marinship Way
Suite 370
Sausalito, CA 94965-2853

Mailing address

2330 Marinship Way
Suite 370
Sausalito, CA 94965-2853
Phone (415) 887-9758

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 10, 2013.

{
    "created_epoch": "1368144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368144000000",
    "number": "1487090924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 MARINSHIP WAY",
            "address_2": "SUITE 370",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949652853",
            "telephone_number": "415-887-9758",
            "fax_number": "415-887-9763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 MARINSHIP WAY",
            "address_2": "SUITE 370",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949652853",
            "telephone_number": "415-887-9758",
            "fax_number": "415-887-9763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MARIN DERMATOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-10",
        "last_updated": "2013-05-10",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-887-9758",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sausalito, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.