NPIMap

Organization Active NPI

Prima Medical Group-Terra Linda

  • General Practice Physician
  • San Rafael, CA
National Provider Identifier
1730463258
Registry record updated Aug 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G73451 Issued in CA
Legal business name
PRIMA MEDICAL GROUP-TERRA LINDA
Practice address
4000 Civic Center Drive
Suite 200B
San Rafael, CA 94903
Phone
(415) 492-3333
Fax
(415) 492-3425
NPI assigned
Oct 3, 2011
Organization subpart
Yes
Parent organization
PRIMA MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2012

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

Authorized official

Name
Mr. Joel A Criste
Title
Ceo
Phone
(415) 884-1840

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X G73451 CA Primary
Multi-Specialty Clinic/Center 261QM1300X G55637 CA

Addresses

Primary practice location

4000 Civic Center Drive
Suite 200B
San Rafael, CA 94903

Mailing address

4 Hamilton Landing
Suite 100
Novato, CA 94949
Phone (415) 884-1840

National Provider Directory

National Provider Directory
Tax ID family
Prima Medical Foundation19 organizations share this tax ID, including this one
Part of
Prima Medical Foundation

Other organizations with this tax ID 18

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

View all 18

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": "1317600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344902400000",
    "number": "1730463258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HAMILTON LANDING",
            "address_2": "SUITE 100",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94949",
            "telephone_number": "415-884-1840",
            "fax_number": "415-884-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 CIVIC CENTER DRIVE",
            "address_2": "SUITE 200B",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "94903",
            "telephone_number": "415-492-3333",
            "fax_number": "415-492-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMA MEDICAL GROUP-TERRA LINDA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMA MEDICAL FOUNDATION",
        "enumeration_date": "2011-10-03",
        "last_updated": "2012-08-14",
        "status": "A",
        "authorized_official_last_name": "CRISTE",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-884-1840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G73451",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "G55637",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.