Pearl Diagnostic Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PEARL DIAGNOSTIC LABORATORY, LLC

Practice address

2202 Buechel Ave Ste 105D
Louisville, KY 40218-2672

Phone

(502) 814-4074

Fax

(502) 814-4073

NPI assigned

Sep 30, 2020

Organization subpart

No

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

Authorized official

Name

Osawaru Omoruyi, MDNPI 1396961967

Title

Ceo

Phone

(502) 777-4301

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Locations

Practitioners 1

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

• Osawaru Jude Omoruyi, M.D

  • Family Medicine Physician
  • Louisville, KY
  • NPI 1396961967
  NPD Authorized official

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

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1215544549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 BUECHEL AVE STE 105D",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182672",
            "telephone_number": "502-814-4074",
            "fax_number": "502-814-4073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 BUECHEL AVE STE 105D",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182672",
            "telephone_number": "502-814-4074",
            "fax_number": "502-814-4073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL DIAGNOSTIC LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "OMORUYI",
        "authorized_official_first_name": "OSAWARU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-777-4301",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgett Peak
• Susan Peak, DNP
• Vincent J Peak, PHARMD
• Isaac Andrew Pearce, DO
• Justin Paul Pearce, CRNA
• Pearl Geriatrics and Palliative Medicine, PSC
• Pearl Medical Practice PLLC
• Pearl Medical Practice PLLC
• Pearl Medical Practice PLLC (New Dawn Recovery Services)
• Carol Jane Pearl, PTA

• Clinical Medical Laboratory in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Medical Laboratory in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.