Individual provider Active NPI

Marina Marie Mulvey, AUD

  • Audiologist
  • Santa Rosa, CA
National Provider Identifier
1497898043
Registry record updated Apr 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AU1683 Issued in CA
Practice address
4725 Hoen Avenue
Suite B
Santa Rosa, CA 95405-9405
Phone
(707) 542-1154
Fax
(707) 542-4818
NPI assigned
Feb 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AU1683 CA Primary
Hearing Instrument Specialist 237700000X HA3313 CA

Addresses

Primary practice location

4725 Hoen Avenue
Suite B
Santa Rosa, CA 95405-9405

Mailing address

4725 Hoen Avenue
Suite B
Santa Rosa, CA 95405-9405
Phone (707) 542-1154

Other identifiers 1

IdentifierTypeStateIssuer
AU0016830MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081229000641 CA Practitioner - Qualified Audiologist 6800958877 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barton Medical FoundationGroup PAC ID 5395127682, 97 clinicians

Practice addresses (Care Compare)

2169 S Ave
South Lake Tahoe, CA 96150-7059
Phone (530) 543-5400

Merit-based Incentive Payment System (MIPS)

Final score
95.71 of 100Reported as apm
Quality
89.85
Promoting interoperability
94.05
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AU1683CAMDAudiologist
HA3313CAMDHearing Instrument Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoe Carson Valley Medical Group Inc CurrentSince Jan 15, 2020 Accepting new patients
Barton Medical Foundation CurrentSince Jan 1, 2023 Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients
Connect Hearing, Inc. Audiologist PastSince Dec 16, 2020 Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients
Connect Hearing, Inc. Audiologist PastSince Dec 28, 2022 Accepting new patients
Connect Hearing, Inc. Audiologist Past Accepting new patients

Locations

2169 South Ave
South Lake Tahoe, CA 96150
Phone (530) 543-5400

2074 Lake Tahoe Blvd
Ste 4
South Lake Tahoe, CA 96150
Phone (530) 543-5554

2170 South Ave
South Lake Tahoe, CA 96150
Phone (530) 541-3420

1090 3rd St
South Lake Tahoe, CA 96150
Phone (530) 543-5660

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461628800000",
    "number": "1497898043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 HOEN AVENUE",
            "address_2": "SUITE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954059405",
            "telephone_number": "707-542-1154",
            "fax_number": "707-542-4818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 HOEN AVENUE",
            "address_2": "SUITE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954059405",
            "telephone_number": "707-542-1154",
            "fax_number": "707-542-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULVEY",
        "first_name": "MARINA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2016-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU1683",
            "primary": true
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "CA",
            "license": "HA3313",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AU0016830",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 26, 2016; 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.