Shala Rahbar Fardin, MD
Individual provider Active NPI Dermatology Physician · Sausalito, CA
NPI 1720114432 · NPPES record last updated Sep 24, 2013
Key facts
- NPI
- 1720114432
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- A98841 (CA)
- Practice address
- 2330 Marinship Way Ste 370
Sausalito, CA 94965-2853 - Phone
- (415) 887-9758
- Fax
- (415) 887-9763
- NPI assigned
- Feb 26, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.43 of 100
- Quality
- 80.85
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090715000698 | CA | Practitioner - Dermatology | 6800978164 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 98841 | CA | MD | Marriage & Family Therapist |
| A98841 | CA | MD | Dermatology Physician |
| P-230971 | MA | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Marin Dermatology, Inc. | Dermatology | Current |
Accepting new patients |
| Regents Univ of California UCSF | Past | Accepting new patients | |
| California Pacific Medical Group, Inc. | Past | Accepting new patients |
Locations
2330 Marinship Way
Ste 370
Sausalito, CA 94965
Phone (415) 887-2853
Interoperability endpoints
- sfardin@smd.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | P-230971 | MA | |
| Dermatology Physician | 207N00000X | A98841 | CA | Yes |
Addresses
Primary practice location
2330 Marinship Way Ste 370
Sausalito, CA 94965-2853
Mailing address
2330 Marinship Way Ste 370
Sausalito, CA 94965-2853
Phone (415) 887-9758
Other names
- Shala Rahbar
Other providers in Sausalito, CA
- Evan Shepherd Reiff, L.Ac.
- Carter C Evans
- Stephanie Evans
- Tamara Falvai
- Jeffrey Lawrence Farber
- Jane Victoria Farley
- Leni Michelle Felton
- Sara E Fenton
- Celina Noelle Fine
- Cheri J. Forrester
All providers in Sausalito, CA · Dermatology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.