PRIMA MEDICAL FOUNDATION (NPI# 1902244528) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902244528 |
| Entity Type | Organization |
| Organization Name | PRIMA MEDICAL FOUNDATION |
| Other Organization Name | PRIMA MEDICAL GROUP |
| Practice Address |
652 Petaluma Ave Suite H Sebastopol CA 95472-4256 |
| Mailing Address |
4 Hamilton Lndg Suite 100 Novato CA 94949-8256 |
| Practice Telephone | 7078237616 |
| Practice Fax Number | 7078232803 |
| Mailing Telephone | 4158841840 |
| Mailing Fax Number | 4158837127 |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2013-06-05 |
| Authorized Official Name | DENNIS MONDRAGON (COO) |
| Authorized Official Telephone | 4158841840 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIMA MEDICAL FOUNDATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PRIMA MEDICAL GROUP | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609157734 | Prima Medical Foundation | Surgery | 100 A Drakes Landing Rd, Suite 225, Greenbrae, CA 94904-3119 | 2011-09-02 |
| 1811217946 | Prima Medical Foundation | Clinic/Center | 4 Hamilton Landing, Suite 100, Novato, CA 94949 | 2010-06-11 |
| 1396909735 | Prima Medical Foundation | Pediatrics | 1260 S. Eliseo Dr, Floor 2, Greenbrae, CA 94904-2009 | 2008-07-15 |
| 1437313863 | Prima Medical Foundation | General Practice | 651 1st Street West, Suite H, Sonoma, CA 95476 | 2008-07-15 |
| 1548258106 | Prima Medical Foundation | General Practice | 1260 S Eliseo Dr, Floor 2, Greenbrae, CA 94904-2009 | 2005-10-07 |
| 1033503446 | Prima Medical Foundation | Obstetrics & Gynecology | 75 Rowland Way, Suite 275, Novato, CA 94945-5037 | 2015-03-24 |
| 1902187560 | Prima Medical Foundation | Orthopaedic Surgery | 651 1st St W, Suite K, Sonoma, CA 95476-7045 | 2011-09-08 |
| 1649551201 | Prima Medical Foundation | Orthopaedic Surgery | 651 1st St W, Suite K, Sonoma, CA 95476-7045 | 2011-09-08 |
| 1548541105 | Prima Medical Foundation | Surgery | 250 Bon Air Rd, Greenbrae, CA 94904-1702 | 2011-09-08 |
| 1639450299 | Prima Medical Foundation | Internal Medicine | 75 Rowland Way, #100, Novato, CA 94945-5037 | 2011-09-08 |
| Street Address |
652 PETALUMA AVE SUITE H |
| City | SEBASTOPOL |
| State | CA |
| Zip Code | 95472-4256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962401463 | Misty Michelle Zelk | Internal Medicine | 652 Petaluma Ave, Suite H, Sebastopol, CA 95472-4256 | 2005-07-18 |
| 1275016230 | Connie Alejandrina Moreno | Nurse Practitioner | 652 Petaluma Ave, Sebastopol, CA 95472-4256 | 2018-09-14 |
| 1114382751 | Shelleen E Denno Md Inc. | Internal Medicine | 652 Petaluma Ave, Suite D, Sebastopol, CA 95472-4256 | 2015-12-28 |
| 1861809501 | West County Health Centers, Inc. | Clinic/Center | 652 Petaluma Ave, Sebastopol, CA 95472-4256 | 2014-07-15 |
| 1336496710 | Emilio Licea IIi | Psychologist | 652 Petaluma Ave, Sebastopol, CA 95472-4256 | 2012-08-05 |
| 1154590958 | Prima Medical Foundation Sebastopol | Clinic/Center | 652 Petaluma Ave, Suite H, Sebastopol, CA 95472-4256 | 2008-02-26 |
| 1184845182 | Northern California Medical Assoc Inc | Internal Medicine | 652 Petaluma Ave, Ste E, Sebastopol, CA 95472-4266 | 2007-05-01 |
| 1871665471 | Scott Benstock | Dentist | 652 Petaluma Ave, Suite A, Sebastopol, CA 95472-4256 | 2006-11-15 |
| 1992889067 | Allan L. Bernstein | Psychiatry & Neurology | 652 Petaluma Ave, Suite H, Sebastopol, CA 95472-4256 | 2006-10-25 |
| 1497842835 | Sutter Medical Group of The Redwoods | Obstetrics & Gynecology | 652 Petaluma Ave, Suite F, Sebastopol, CA 95472-4256 | 2006-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558916791 | Mellisa Nicole Elrod | Occupational Therapist | 1935 Gravenstein Hwy, Sebastopol, CA 95472 | 2019-08-05 |
| 1457820987 | Isabel Brooke Martinez | Acupuncturist | 961 Gravenstein Hwy South, # 100, Sebastopol, CA 95472 | 2018-11-14 |
| 1275025470 | Shahbano Syeda | Specialist/Technologist | 846/848 Gravenstein Hwy South, Sebastopol, CA 95472 | 2018-06-04 |
| 1467990812 | Mathew Metzgar | Marriage & Family Therapist | 1800 N. Gravenstein Hwy, Sebastopol, CA 95472 | 2017-02-06 |
| 1760939318 | Andrea Kirk | Psychologist | 876 Gravenstein Hwy S., Suite 6, Sebastopol, CA 95472 | 2016-09-01 |
| 1548629371 | Stacy Simons | Massage Therapist | 103 Morris St Ste V, Sebastopol, CA 95472 | 2016-02-22 |
| 1619341880 | Carol Schmid | Counselor | 1800 N, Gravenstein Hwy, Sebastopol, CA 95472 | 2015-11-25 |
| 1801273727 | Aaron Martinez | Specialist/Technologist | 7441 Witter Road, Sebastopol, CA 95472 | 2015-04-29 |
| 1699167049 | Nia Kaye | Marriage & Family Therapist | 130 Petaluma Ave Ste 2c, Sebastopol, CA 95472 | 2015-02-23 |
| 1497091383 | Caitlin Marie Kirkman | Midwife | 5611 Hessel Ave, Sebastopol, CA 95472 | 2012-12-20 |
| Find all providers in zip 95472 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396043758 | Jerry Michael Bolduan | General Practice | 10450 Cherry Ridge Rd, Sebastopol, CA 95472-9028 | 2011-03-09 |
| 1124165220 | Kay Weinshienk | General Practice | 145 Pleasant Hill Ave N Ste 104, Sebastopol, CA 95472-3110 | 2007-01-30 |
| 1376570077 | E Carlisle Holland | General Practice | 496 S Main St, Sebastopol, CA 95472-4211 | 2006-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992986 | Lindsay Fry | General Practice | 375 Bonair St Apt 1, La Jolla, CA 92037-5911 | 2020-11-04 |
| 1255939674 | Kiira Health Practice Ca PC | General Practice | 123 S Figueroa St Apt 1202, Los Angeles, CA 90012-5490 | 2020-10-16 |
| 1851999627 | Golden State Medical Center PC | General Practice | 2551 San Ramon Valley Blvd Ste 108, San Ramon, CA 94583-1661 | 2020-10-14 |
| 1598362709 | Afua Takyi | General Practice | 1555 River Park Dr Ste 211, Sacramento, CA 95815-4604 | 2020-10-01 |
| 1316553530 | Kimberly Ann Callaway | General Practice | 4893 Drakewood Ter, San Diego, CA 92130-1406 | 2020-09-22 |
| 1376156109 | Gtl Medical Group Inc | General Practice | 14555 Hamlin St Ste 107, Van Nuys, CA 91411-1617 | 2020-08-31 |
| 1922611896 | Daniel Lynn Johnson | General Practice | 74075 El Paseo Ste B2, Palm Desert, CA 92260-4118 | 2020-08-28 |
| 1235755299 | Hofmeister Medical, PC | General Practice | 31735 Riverside Dr Ste K, Lake Elsinore, CA 92530-7816 | 2020-06-24 |
| 1033733779 | South Bay Regenerative Medical Spa Inc | General Practice | 412 S Pacific Coast Hwy Ste 100, Redondo Beach, CA 90277-3712 | 2020-05-28 |
| 1568085041 | Integrated Advanced Medicine Inc | General Practice | 210 S Grand Ave Ste 408, Glendora, CA 91741-4282 | 2020-05-19 |
| Find all providers with the same taxonomy | ||||
| City | SEBASTOPOL |
| Zip Code | 95472 |
Please comment or provide details below to improve the information on PRIMA MEDICAL FOUNDATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.