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MILL VALLEY MEDICAL GROUP
NPI 1780728246
Family Medicine in San Rafael, CA

Active since February 17, 2007
711 D ST, SUITE 111, SAN RAFAEL, CA 94901(415) 453-3030 Get Directions Write a Review

NPPES record last updated: November 7, 2008. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mill Valley Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MILL VALLEY MEDICAL GROUP (NPI 1780728246) is a healthcare organization registered as a family medicine in San Rafael, California and active in the NPI registry since February 2007. The organization lists Dana Tully-smith, Vice President, as its authorized official.

NPPES Registry Identity

NPI1780728246
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameDAVID M TULLY SMITH M D A MEDICAL CORPORATION
Location Address711 D ST, SUITE 111San Rafael, CA 94901-3707
Mailing AddressPo Box 3137Rohnert Park, CA 94927-3137
Phone(415) 453-3030
Organization SubpartNo
Authorized OfficialDana Tully-smithVice President · (707) 544-2632
Enumeration DateFebruary 17, 2007
Last NPPES UpdateNovember 7, 2008
✔ NPI 1780728246 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · G30229
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
711 D ST, San Rafael, CA 94901
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Other Names 1

Doing Business AsMill Valley Medical Group

Other Identifiers 1

Medicare ID-Type UnspecifiedZZZ30674ZCA · Group Number

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mill Valley Medical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Mill Valley Medical Group, which bills Medicare for the services this clinician delivers.

Clinician (1)

David Tully Smith, M.D.
General Practice
NPI 1598890287
711 D ST SUITE 111
San Rafael, CA 94901
(415) 453-3030
✔ PECOS✔ Accepts Medicare0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is David M Tully Smith M D A Medical Corporation's NPI number?

The NPI number for David M Tully Smith M D A Medical Corporation is 1780728246. It was assigned to this organization in the NPPES registry on February 17, 2007. The provider is doing business as Mill Valley Medical Group.

Where is David M Tully Smith M D A Medical Corporation located?

David M Tully Smith M D A Medical Corporation is located at 711 D St Suite 111, San Rafael, CA 94901. The listed phone number is (415) 453-3030.

What is David M Tully Smith M D A Medical Corporation's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is David M Tully Smith M D A Medical Corporation enrolled in Medicare?

Yes. David M Tully Smith M D A Medical Corporation is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through David M Tully Smith M D A Medical Corporation?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to David M Tully Smith M D A Medical Corporation. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for David M Tully Smith M D A Medical Corporation was last updated on November 7, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.