NPIMap

Organization Active NPI

Marin Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Novato, CA
National Provider Identifier
1912091018
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
110000366 Issued in CA
Legal business name
MARIN COMMUNITY CLINIC
Practice address
6090 Redwood Blvd
Novato, CA 94945-4569
Phone
(415) 448-1500
Fax
(415) 461-7334
NPI assigned
Oct 3, 2006
Last updated
Feb 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

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

Authorized official

Name
Brenda Ann Shipp
Title
Ceo
Phone
(916) 879-2071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 110000366 CA Primary

Addresses

Primary practice location

6090 Redwood Blvd
Novato, CA 94945-4569

Mailing address

9 Commercial Blvd Ste 103
Novato, CA 94949-6118
Phone (415) 448-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050413000596 CA Part A Provider - Federally Qualified Health Center (FQHC) 0840108031 Practice locations: Novato, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912091018. Details of each certification follow.

Federally qualified health center certification: CCN 051945

Legal name
MARIN COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1995
Last certification
Jan 1, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 7, 1973 in CA
Enrollment address
6090 Redwood Blvd
Novato, CA 94945-4569

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Marin Community Clinic16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Freshte Kashani Individual Corporate Director Jul 22, 2009
Martin Weil Individual Corporate DirectorBoard Member Jan 1, 2021
Alyssa H Morris Individual Corporate DirectorBoard Member Jan 1, 2021
David Klinetobe Individual Corporate OfficerCfo Jul 22, 2009
W-2 Managing EmployeeCfo Jul 22, 2001
Nelson Branco Individual Corporate DirectorBoard Member Jan 1, 2021
Mark M Jacobs Individual Corporate DirectorBoard Member Jan 1, 2021
Daniel a Segedin Individual Corporate DirectorBoard Member Jan 1, 2021
Mitesh Popat Individual Corporate OfficerCeo Nov 1, 2013

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771459200000",
    "number": "1912091018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 COMMERCIAL BLVD STE 103",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496118",
            "telephone_number": "415-448-1500",
            "fax_number": "415-798-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6090 REDWOOD BLVD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949454569",
            "telephone_number": "415-448-1500",
            "fax_number": "415-461-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A",
        "authorized_official_last_name": "SHIPP",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-879-2071"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "110000366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

Verify at the official NPI Registry.