NPIMap

Organization Active NPI

Greensboro Pathology, LLC

  • Specialist
  • Greensboro, NC
National Provider Identifier
1023084340
Registry record updated Feb 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
GREENSBORO PATHOLOGY, LLC
Practice address
706 Green Valley Rd
Suite 104
Greensboro, NC 27408-7038
Phone
(336) 271-4930
Fax
(336) 271-8466
NPI assigned
Feb 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2015

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

Authorized official

Name
Michael C. Grattendick
Title
Vice President
Phone
(561) 626-5512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

706 Green Valley Rd
Suite 104
Greensboro, NC 27408-7038

Mailing address

11025 Rca Center Drive
Suite 300
Palm Beach Gardens, FL 33410-4269
Phone (561) 626-5512

Other identifiers 1

IdentifierTypeStateIssuer
CC3781OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040707001432 NC Part B Supplier - Clinic/Group Practice 1153315643 Receives reassigned benefits from 26 practitioners
Practice locations: Asheboro, NC; Reidsville, NC; Greensboro, NC; Burlington, NC
O20260604001540 VA Part B Supplier - Clinic/Group Practice 1153315643 Receives reassigned benefits from 1 practitioner
Practice locations: Danville, VA; Martinsville, VA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Greensboro Pathology LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1240 Huffman Mill Rd
Burlington, NC 27215
Phone (336) 538-7000

Networks

  • SC HMO

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424131200000",
    "number": "1023084340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11025 RCA CENTER DRIVE",
            "address_2": "SUITE 300",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334104269",
            "telephone_number": "561-626-5512",
            "fax_number": "561-626-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 GREEN VALLEY RD",
            "address_2": "SUITE 104",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087038",
            "telephone_number": "336-271-4930",
            "fax_number": "336-271-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENSBORO PATHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2015-02-17",
        "status": "A",
        "authorized_official_last_name": "GRATTENDICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "561-626-5512"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC3781",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; 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.