Medstar Laboratory, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

14D0945905 Issued in IL

Legal business name

MEDSTAR LABORATORY, INC

Practice address

4531 Harrison St
Hillside, IL 60162-1614

Phone

(708) 488-1000

Fax

(708) 488-1831

NPI assigned

Nov 16, 2005

Last updated

Sep 17, 2015By 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

Raj N Patel

Title

Vice President

Phone

(708) 488-1000

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Soft Landing Labs LTD

  • Clinical Medical Laboratory
  • Hillside, IL
  • NPI 1295967149

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1144202003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4531 HARRISON ST",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601621614",
            "telephone_number": "708-488-1000",
            "fax_number": "708-488-1831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4531 HARRISON ST",
            "city": "HILLSIDE",
            "state": "IL",
            "postal_code": "601621614",
            "telephone_number": "708-488-1000",
            "fax_number": "708-488-1831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSTAR LABORATORY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RAJ",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "VICE  PRESIDENT",
        "authorized_official_telephone_number": "708-488-1000"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "IL",
            "license": "14D0945905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "506110",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1144202003",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kory Marken, BCBA
• Nicole Martinez
• Christian Jeff Bagnas Matias
• Sarah Mazur
• Jennifer Bonny McQuillan, DPT
• Medwest Associates
• MH Health Care Services, PC
• Annie Mo
• Felix Rodrigo Monroy
• Namm Partners, Inc.

• Clinical Medical Laboratory in Hillside, IL
• Providers in Hillside, IL by specialty
• Clinical Medical Laboratory in Illinois

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