NPIMap

Organization Active NPI

Prima Medical Foundation

  • Surgery Physician
  • Sonoma, CA
National Provider Identifier
1902187560
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A85617 Issued in CA
Legal business name
PRIMA MEDICAL FOUNDATION
Practice address
651 1St St W
Suite K
Sonoma, CA 95476-7045
Phone
(707) 938-3870
NPI assigned
Sep 8, 2011
Last updated
Aug 8, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMA MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 8, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X G88678 CA
Surgery Physician 208600000X A65187 CA
Surgery Physician 208600000X A85617 CA Primary

Addresses

Primary practice location

651 1St St W
Suite K
Sonoma, CA 95476-7045

Mailing address

4 Hamilton LNDG
Suite100
Novato, CA 94949-8256
Phone (415) 884-1874

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ03538ZOtherCAMEDICARE PTAN

National Provider Directory

National Provider Directory
Tax ID family
Prima Medical Group-Terra Linda19 organizations share this tax ID, including this one
Part of
Prima Medical Group-Terra Linda

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": "1315440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344384000000",
    "number": "1902187560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HAMILTON LNDG",
            "address_2": "SUITE100",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949498256",
            "telephone_number": "415-884-1874",
            "fax_number": "415-883-7127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 1ST ST W",
            "address_2": "SUITE K",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "954767045",
            "telephone_number": "707-938-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMA MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMA MEDICAL FOUNDATION",
        "enumeration_date": "2011-09-08",
        "last_updated": "2012-08-08",
        "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": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G88678",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A65187",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A85617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "ZZZ03538Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonoma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.