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

Last updated

Sep 29, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• 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
• Anucheat Chea, M.D.

  • General Practice Physician
  • San Rafael, CA
  • NPI 1952663635
  NPD (past)
• 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": [],
    "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.