Stockton Pathology Medical Group

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

STOCKTON PATHOLOGY MEDICAL GROUP

Doing business as

Stockton Pathology Medical Group Laboratory

Practice address

2131 N California St
Stockton, CA 95204-6030

Phone

(209) 465-6221

NPI assigned

Apr 30, 2015

Organization subpart

No

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

Authorized official

Name

Jeffrey McDavit, M.D.NPI 1588817662

Title

Authorized Official

Phone

(209) 943-2000

Specialties & licenses 1

Addresses

Other names 1

• Stockton Pathology Medical Group Laboratory Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

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).

• Stockton Pathology Medical Group

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1871522680

  8820073455

  Same PAC ID

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

Stockton Path Med GRP2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Stockton Pathology Medical Group

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1871522680
  NPD tax ID

Locations

Practitioners 6

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

• Jeffrey Alan McDavit, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1588817662
  NPD Authorized official
• Andrew Fong, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1679928394
  NPD
• David F Jensen, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1881621175
  NPD
• Mark H Nishiki, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1457385890
  NPD
• Lily Nga-Yan Pang, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1962623348
  NPD
• Thomas L Yu, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Stockton, CA
  • NPI 1518991959
  NPD

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1205213196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 SOUTHWYCK BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046030",
            "telephone_number": "209-465-6221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKTON PATHOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "MCDAVIT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "209-943-2000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stockton Pathology Medical Group Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stockton Nursing and Rehab Center LLC (Stockton Nursing Center)
• Stockton Orthopedic Medical Group, Inc.
• Stockton Outpatient Surgery Center LLC (Ambulatory Surgery Center of Stockton)
• Stockton Pace, LLC
• Stockton Pain Medical Center
• Stockton Pathology Medical Group
• Stockton Pediatric Med. Group, Inc.
• Stockton Pharmacy
• Stockton Pharmacy
• Stockton Physical Therapy and Lymphedema Clinic, Inc

• Clinical Medical Laboratory in Stockton, CA
• Providers in Stockton, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.