NPIMap

Organization Active NPI

Prima Medical Foundation

  • General Practice Physician
  • Greenbrae, CA
National Provider Identifier
1548258106
Registry record updated Aug 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A72388 Issued in CA
Legal business name
PRIMA MEDICAL FOUNDATION
Practice address
1260 S Eliseo Dr
Floor 2
Greenbrae, CA 94904-2009
Phone
(415) 461-7800
Fax
(415) 924-1375
NPI assigned
Oct 7, 2005
Last updated
Aug 13, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMA MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 13, 2015

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

Authorized official

Name
Joanna Rubel
Title
Sr. Director of Practice Operations
Phone
(415) 842-5103

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X G88295 CA
Pulmonary Disease Physician 207RP1001X G45217 CA
General Practice Physician 208D00000X
General Practice Physician 208D00000X A72388 CA Primary

Addresses

Primary practice location

1260 S Eliseo Dr
Floor 2
Greenbrae, CA 94904-2009

Mailing address

9 Commercial Blvd
Suite 200
Novato, CA 94949-6118
Phone (415) 842-5000

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ03538ZOtherCAMEDICARE

National Provider Directory

National Provider Directory
Tax ID family
Prima Medical Group-Terra Linda19 organizations share this tax ID, including this one
Part of
Prima Medical Group-Terra Linda

Other organizations with this tax ID 18

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

View all 18

Locations

1260 S Eliseo Dr
Fl 2
Greenbrae, CA 94904
Phone (415) 464-1350

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439424000000",
    "number": "1548258106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 COMMERCIAL BLVD",
            "address_2": "SUITE 200",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496118",
            "telephone_number": "415-842-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 S ELISEO DR",
            "address_2": "FLOOR 2",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042009",
            "telephone_number": "415-461-7800",
            "fax_number": "415-924-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMA MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMA MEDICAL FOUNDATION",
        "enumeration_date": "2005-10-07",
        "last_updated": "2015-08-13",
        "status": "A",
        "authorized_official_last_name": "RUBEL",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_title_or_position": "SR. DIRECTOR OF PRACTICE OPERATIONS",
        "authorized_official_telephone_number": "415-842-5103"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "G88295",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "G45217",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A72388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "ZZZ03538Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2015; 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.