NPIMap

Organization Active NPI

Western Pathology Consultants, LTD

  • Anatomic Pathology & Clinical Pathology Physician
  • Reno, NV
National Provider Identifier
1003366188
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
1512LIC-14 Issued in NV
Legal business name
WESTERN PATHOLOGY CONSULTANTS, LTD
Practice address
343 Elm St
Suite 206
Reno, NV 89503-4522
Phone
(775) 746-3400
Fax
(775) 746-3411
NPI assigned
Oct 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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

Authorized official

Name
Michael Grattendick
Title
Cfo
Phone
(561) 626-5512

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZC0500X 1512LIC-14 NV
Dermatopathology (Pathology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZD0900X 1512LIC-14 NV
Hematology (Pathology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZH0000X 1512LIC-14 NV
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X 1512LIC-14 NV Primary
Pediatric Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0213X 1512LIC-14 NV

Addresses

Primary practice location

343 Elm St
Suite 206
Reno, NV 89503-4522

Mailing address

11025 Rca Center Dr
Suite 300
Palm Beach Gardens, FL 33410-4269
Phone (561) 514-5822

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160114002881 NV Part B Supplier - Clinic/Group Practice 6406833094 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Reno, NV

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

343 Elm St
Ste 206
Reno, NV 89503
Phone (775) 329-2531

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1003366188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11025 RCA CENTER DR",
            "address_2": "SUITE 300",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104269",
            "telephone_number": "561-514-5822",
            "fax_number": "561-626-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 ELM ST",
            "address_2": "SUITE 206",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895034522",
            "telephone_number": "775-746-3400",
            "fax_number": "775-746-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN PATHOLOGY CONSULTANTS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A",
        "authorized_official_last_name": "GRATTENDICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "561-626-5512"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": "NV",
            "license": "1512LIC-14",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": "NV",
            "license": "1512LIC-14",
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Hematology",
            "state": "NV",
            "license": "1512LIC-14",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NV",
            "license": "1512LIC-14",
            "primary": true
        },
        {
            "code": "207ZP0213X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Pediatric Pathology",
            "state": "NV",
            "license": "1512LIC-14",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; 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.