Pathologists Bio-Medical Laboratories PLLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

45D0481682 Issued in TX

Legal business name

PATHOLOGISTS BIO-MEDICAL LABORATORIES PLLC

Practice address

1111 Northpoint Dr
Coppell, TX 75019-3831

Phone

(972) 966-7830

NPI assigned

Jul 3, 2006

Organization subpart

No

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

Authorized official

Name

Peter A. Dysert II, M.D.

Title

President

Phone

(214) 823-6492

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pathologists Bio-Medical Laboratories LLP Former legal business name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Pathologists Bio-Medical Laboratories PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Dallas, TX
  • NPI 1265477707

  7911961677

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Pathologists Bio-Medical Laboratories PLLC

  • Clinical Medical Laboratory
  • Victoria, TX
  • NPI 1003411257

  O20050304000156

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Pathologists Bio Medica5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Pathologists Bio-Medical Laboratories PLLC

  • Clinical Medical Laboratory
  • Victoria, TX
  • NPI 1003411257
  NPD tax ID
• Pathologists Bio-Medical Laboratories PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Dallas, TX
  • NPI 1265477707
  NPD tax ID
• Pathologists Bio-Medical Laboratories PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Waxahachie, TX
  • NPI 1982900460
  NPD tax ID
• Pathologists Biomedical Laboratories PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Grapevine, TX
  • NPI 1275838179
  NPD tax ID

Locations

Practitioners 2

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

• John R Krause, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Dallas, TX
  • NPI 1508815234
  NPD (past)
• Moyosore D Awobajo-Otesanya, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Nashville, TN
  • NPI 1285253229
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1104855717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 GASTON AVE",
            "address_2": "WADLEY TOWER, SUITE 261",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461800",
            "telephone_number": "214-818-9100",
            "fax_number": "214-818-9170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 NORTHPOINT DR",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750193831",
            "telephone_number": "972-966-7830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 S State Highway 121 Bus",
            "address_2": "Suite 1210",
            "address_purpose": "LOCATION",
            "city": "Lewisville",
            "state": "TX",
            "postal_code": "750674394",
            "country_code": "US",
            "telephone_number": "214-818-9100",
            "fax_number": "214-818-9180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATHOLOGISTS BIO-MEDICAL LABORATORIES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "DYSERT",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-823-6492",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "45D0481682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "690003975",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127290803",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pathologists Bio-Medical Laboratories LLP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nisha S Patel, RDH
• Rajesh Patel, M.D
• Shivani Patel, OD
• Sundip Harishchandra Patel, M.D.
• Ekta Pathare, OTR,CHT
• Terri Patrick, MS, MCHES, OMT
• Crystal Marie Patterson, RDH
• Allyson M Pattison, PT, DPT
• Ashley Camille Pattison, SLP
• Allison Ozarowski Paul, DC

• Clinical Medical Laboratory in Coppell, TX
• Providers in Coppell, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.