NPIMap

Organization Active NPI

Pacific Pathology Associates, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Salem, OR
National Provider Identifier
1205997889
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PACIFIC PATHOLOGY ASSOCIATES, INC.
Practice address
665 Winter St SE
Salem, OR 97301-3934
Phone
(503) 561-5350
Fax
(503) 561-4781
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

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

Authorized official

Name
Clark E McDonald, MD
Title
President
Phone
(503) 561-5564

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary
Clinical Medical Laboratory 291U00000X 38D0625543 OR

Addresses

Primary practice location

665 Winter St SE
Salem, OR 97301-3934

Mailing address

5700 Southwyck Blvd
Toledo, OH 43614-1509
Phone (800) 288-8325

Other identifiers 1

IdentifierTypeStateIssuer
006465MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040504000657 OR Part B Supplier - Clinic/Group Practice 1951399484 Receives reassigned benefits from 27 practitioners
Practice locations: Portland, OR; Stayton, OR; Silverton, OR; Salem, OR

National Provider Directory

National Provider Directory
Tax ID family
Pacific Pathology Associates Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1995 Commercial St SE
Ste 200
Salem, OR 97302
Phone (503) 375-0007

Practitioners & affiliated clinicians

Practitioners 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418169600000",
    "number": "1205997889",
    "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",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 WINTER ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013934",
            "telephone_number": "503-561-5350",
            "fax_number": "503-561-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC PATHOLOGY ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2014-12-10",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-561-5564",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OR",
            "license": "38D0625543",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006465",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; 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.