Preventive Medical Center of Marin Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PREVENTIVE MEDICAL CENTER OF MARIN INC

Practice address

4340 Redwood Hwy Ste Aa
San Rafael, CA 94903-2121

Phone

(415) 472-2343

Fax

(415) 472-7636

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Elson M Haas, MDNPI 1740318112

Title

Owner Medical Director

Phone

(415) 472-2343

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 9

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

• Elson M Haas, M.D.

  • Allergy & Immunology Physician
  • San Rafael, CA
  • NPI 1740318112
  Medicare reassignment NPD Authorized official
• Holly Edson, NP

  • Family Nurse Practitioner
  • San Rafael, CA
  • NPI 1053914176
  Medicare reassignment NPD
• Judy Lane, N.P., R.N.

  • Adult Health Nurse Practitioner
  • San Rafael, CA
  • NPI 1043420896
  Medicare reassignment NPD
• Naureen A. Shaikh, MD

  • Family Medicine Physician
  • Sausalito, CA
  • NPI 1265470173
  Medicare reassignment NPD
• Seemin Anna Dallenbach, D.C.

  • Chiropractor
  • San Rafael, CA
  • NPI 1215137716
  NPD (past)
• Paul Handleman, D.O.

  • Neuromusculoskeletal Medicine & OMM Physician
  • San Rafael, CA
  • NPI 1922163179
  NPD (past)
• Marina Erica Rasnow-Hill, MD

  • Integrative Medicine Physician
  • Sacramento, CA
  • NPI 1427209196
  NPD (past)
• Karilee Halo Shames, PHD, RN, A-HNC

  • Psychiatric/Mental Health Registered Nurse
  • San Rafael, CA
  • NPI 1497959266
  NPD (past)
• Richard L. Shames, MD

  • Public Health & General Preventive Medicine Physician
  • San Rafael, CA
  • NPI 1679783625
  NPD (past)

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1912067828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4340 REDWOOD HWY STE A-22",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032121",
            "telephone_number": "415-472-2343",
            "fax_number": "415-472-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4340 REDWOOD HWY STE AA",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032121",
            "telephone_number": "415-472-2343",
            "fax_number": "415-472-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE MEDICAL CENTER OF MARIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "HAAS",
        "authorized_official_first_name": "ELSON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "415-472-2343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "222384942",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Joseph Prendergast, PH.D., MFT
• Julia Prentice, CPS
• Lainie Press
• Elizabeth Susanna Pretorius
• Pamela Pretty, PTA, MS
• Paul Pribuss, PAUL PRIBUSS
• Marian Elizabeth Price, MFT
• Maria Jose Prieto de Estebecorena, PH,D.
• Prima Medical Group-Terra Linda
• Prima Medical Group, Inc.

• Primary Care Clinic/Center in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.