NPIMap

Organization Active NPI

Marin Healthcare District

  • Internal Medicine Physician
  • Greenbrae, CA
National Provider Identifier
1770913741
Registry record updated Nov 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARIN HEALTHCARE DISTRICT
Practice address
1100 S Eliseo Dr
Suite 2a
Greenbrae, CA 94904-2017
Phone
(415) 795-7000
Fax
(415) 329-1401
NPI assigned
Nov 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2013

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

Authorized official

Name
Lee Domanico
Title
Ceo
Phone
(415) 464-2090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1100 S Eliseo Dr
Suite 2a
Greenbrae, CA 94904-2017

Mailing address

PO Box 45094
San Francisco, CA 94145-0094
Phone (415) 464-2090

Other identifiers 1

IdentifierTypeStateIssuer
CS440AOtherCAMEDICARE GROUP PTAN

Other names 1

  • Tamalpais Internal Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colin Hamblin a Professional Medical Corporation13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384214400000",
    "number": "1770913741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45094",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941450094",
            "telephone_number": "415-464-2090",
            "fax_number": "415-464-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S ELISEO DR",
            "address_2": "SUITE 2A",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042017",
            "telephone_number": "415-795-7000",
            "fax_number": "415-329-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2013-11-12",
        "status": "A",
        "authorized_official_last_name": "DOMANICO",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-464-2090"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "CS440A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tamalpais Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 12, 2013; 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.