Laboratory Diagnostics Medical Group

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

05D0663110 Issued in CA

Legal business name

LABORATORY DIAGNOSTICS MEDICAL GROUP

Practice address

9888 Genesee Ave
La Jolla, CA 92037-1276

Phone

(858) 626-6000

Fax

(419) 866-5453

NPI assigned

Jun 27, 2006

Last updated

Jan 11, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephen Carlson, MDNPI 1902824923

Title

President

Phone

(858) 626-6000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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.

• Stephen R Carlson, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • La Jolla, CA
  • NPI 1902824923
  NPD Authorized official
• Mariah Ruth Baughn, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • La Jolla, CA
  • NPI 1205032752
  NPD
• Paul Gibbs, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • La Jolla, CA
  • NPI 1134116080
  NPD

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452470400000",
    "number": "1093742074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W OLYMPIC BLVD",
            "address_2": "#1016",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911990001",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371276",
            "telephone_number": "858-626-6000",
            "fax_number": "419-866-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORY DIAGNOSTICS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2016-01-11",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-626-6000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "05D0663110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR00086691",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• La Jolla Womens Surgery Center Inc
• Olivia La Monte, MD
• Michael La
• Christian David Labonte, DMD
• Jacqueline Labonte, NP
• Anne-Sophie Lacharite-Roberge
• Daphne Yvette Lacoursiere, MD
• Steven Michael Lada, MD
• Laura Lafranchise, PHARMD
• Alicia Lagendijk, RN, PHN, CBCN

• Anatomic Pathology & Clinical Pathology Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.