NPIMap

Organization Active NPI

Marin Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Novato, CA
National Provider Identifier
1790788107
Registry record updated Jan 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
1100491 Issued in CA
Legal business name
MARIN COMMUNITY CLINIC
Practice address
400 Professional Center Dr
Ste 424
Novato, CA 94947-4368
Phone
(415) 448-1531
Fax
(415) 892-8732
NPI assigned
May 31, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2016

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

Authorized official

Name
Ms. Deborah Udall
Title
Director of Patient Accounts
Phone
(415) 798-3106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 1100491 CA Primary

Addresses

Primary practice location

400 Professional Center Dr
Ste 424
Novato, CA 94947-4368

Mailing address

9 Commercial Blvd
Suite 103
Novato, CA 94949
Phone (415) 798-3106

Other identifiers 2

IdentifierTypeStateIssuer
1100491OtherCADHS LICENSE- NOVATO
FHC70941MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453939200000",
    "number": "1790788107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 COMMERCIAL BLVD",
            "address_2": "SUITE 103",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "94949",
            "telephone_number": "415-798-3106",
            "fax_number": "415-798-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 PROFESSIONAL CENTER DR",
            "address_2": "STE 424",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949474368",
            "telephone_number": "415-448-1531",
            "fax_number": "415-892-8732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2016-01-28",
        "status": "A",
        "authorized_official_last_name": "UDALL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "415-798-3106",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "1100491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LICENSE- NOVATO",
            "identifier": "1100491",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70941",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2016; 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.