NPIMap

Organization Active NPI

Marin Healthcare District

  • Internal Medicine Physician
  • Novato, CA
National Provider Identifier
1851664528
Registry record updated Oct 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARIN HEALTHCARE DISTRICT
Practice address
165 Rowland Way
Suite 201
Novato, CA 94945-5038
Phone
(415) 897-3174
Fax
(415) 892-9589
NPI assigned
Feb 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 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

165 Rowland Way
Suite 201
Novato, CA 94945-5038

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
CS440AOtherCAMEDICARE GROUP PTAN

Other names 1

  • North Marin Internal Medicine Specialists Other name

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": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383177600000",
    "number": "1851664528",
    "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": "165 ROWLAND WAY",
            "address_2": "SUITE 201",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949455038",
            "telephone_number": "415-897-3174",
            "fax_number": "415-892-9589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2013-10-31",
        "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": "North Marin Internal Medicine Specialists",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 31, 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.