Active NPI
Southern Marin Dermatology, Inc.
- Dermatology Physician
- Sausalito, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- 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.
- 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.
-
- MOHS-Micrographic Surgery Physician
- Burlingame, CA
- NPI 1255463725
CA
-
- MOHS-Micrographic Surgery Physician
- Sausalito, CA
- NPI 1275567323
CA, Dermatology
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2075709 | Southern Marin Dermatology Inc | Compliance | Oct 19, 2026 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130807000186 | CA | Part B Supplier - Clinic/Group Practice | 2668614447 |
Receives reassigned benefits from 10 practitioners Practice locations: Sausalito, CA |
National Provider Directory
National Provider DirectoryLocations
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
NPPES NPI RegistryPrimary 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.