NPIMap

Organization Active NPI

California Pacific Pathology Medical Group

  • Clinical Pathology/Laboratory Medicine Physician
  • Santa Rosa, CA
National Provider Identifier
1194120451
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
Legal business name
CALIFORNIA PACIFIC PATHOLOGY MEDICAL GROUP
Practice address
30 Mark West Springs Rd
Santa Rosa, CA 95403-1436
Phone
(707) 576-4315
Fax
(707) 541-9112
NPI assigned
Oct 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Authorized official

Name
John Christopher Moretto, M.D.
Title
Managing Partner
Phone
(415) 600-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0105X Primary

Addresses

Primary practice location

30 Mark West Springs Rd
Santa Rosa, CA 95403-1436

Mailing address

PO Box 26060
Fresno, CA 93729-6060
Phone (707) 576-4315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040719001137 CA Part B Supplier - Clinic/Group Practice 2668451980 Receives reassigned benefits from 11 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Rosa, CA; San Francisco, CA; Lakeport, CA; Novato, CA

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
California Pacific Pathology Medical Group5 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.

Practitioners & affiliated clinicians

Practitioners 3

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

  • Lucy Han
    • Anatomic Pathology & Clinical Pathology Physician
    • San Francisco, CA
    • NPI 1003278714
    NPD
  • Ian Mathias Jaffee, M.D.
    • Anatomic Pathology & Clinical Pathology Physician
    • San Francisco, CA
    • NPI 1376603399
    NPD
  • Bella Goyal, M.D.
    • Anatomic Pathology & Clinical Pathology Physician
    • Saint Louis, MO
    • NPI 1427336684
    NPD

NPI Registry JSON

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1194120451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26060",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937296060",
            "telephone_number": "707-576-4315",
            "fax_number": "707-541-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 MARK WEST SPRINGS RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031436",
            "telephone_number": "707-576-4315",
            "fax_number": "707-541-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA PACIFIC PATHOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-29",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "MORETTO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "415-600-2200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; 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.