NPIMap

Organization Active NPI

Yosemite Pathology Medical Group, in

  • Clinical Medical Laboratory
  • Tracy, CA
National Provider Identifier
1114192176
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
G27612 Issued in CA
Legal business name
YOSEMITE PATHOLOGY MEDICAL GROUP, IN
Practice address
1420 N Tracy Blvd
Tracy, CA 95376-3451
Phone
(209) 577-1200
Fax
(209) 577-6517
NPI assigned
Apr 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

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

Authorized official

Name
Robert Colletti, MHA
Title
Chief Operating Officer
Phone
(209) 577-1200

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X G27612 CA Primary
Clinical Medical Laboratory 291U00000X A83286 CA
Clinical Medical Laboratory 291U00000X A72455 CA
Clinical Medical Laboratory 291U00000X A95231 CA

Addresses

Primary practice location

1420 N Tracy Blvd
Tracy, CA 95376-3451

Mailing address

PO Box 576768
Modesto, CA 95357-6768
Phone (209) 577-1200

Other identifiers 1

IdentifierTypeStateIssuer
GR0017746MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Yosemite Path Med GRP I9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 105

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

View all 105

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1114192176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 576768",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953576768",
            "telephone_number": "209-577-1200",
            "fax_number": "209-577-6517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 N TRACY BLVD",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763451",
            "telephone_number": "209-577-1200",
            "fax_number": "209-577-6517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOSEMITE PATHOLOGY MEDICAL GROUP, IN",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "COLLETTI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "209-577-1200",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "G27612",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "A83286",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "A72455",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "A95231",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0017746",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.