NPIMap

Organization Active NPI

Neogenomics Laboratories Inc

  • Clinical Medical Laboratory
  • San Diego, CA
National Provider Identifier
1215625165
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
NEOGENOMICS LABORATORIES INC
Practice address
4570 Executive Dr Ste 250
San Diego, CA 92121-3074
Phone
(866) 776-5907
Fax
(888) 443-4153
NPI assigned
Apr 28, 2023
Last updated
Apr 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Authorized official

Name
Jeffrey S. Sherman
Title
Chief Financial Officer
Phone
(866) 776-5907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

4570 Executive Dr Ste 250
San Diego, CA 92121-3074

Mailing address

PO Box 947365
Atlanta, GA 30394-7365
Phone (866) 776-5907

Other identifiers 2

IdentifierTypeStateIssuer
05D2167801OtherCACLIA
CLF-00353852OtherCACDPH CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071116000642 CA Part B Supplier - Independent Clinical Laboratory 7113011172 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aliso Viejo, CA; Carlsbad, CA; Fresno, CA; San Diego, CA; Sierra Madre, CA

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Neogenomics Laboratories17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1682640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1215625165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947365",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303947365",
            "telephone_number": "866-776-5907",
            "fax_number": "888-443-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 EXECUTIVE DR STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213074",
            "telephone_number": "866-776-5907",
            "fax_number": "888-443-4153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEOGENOMICS LABORATORIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-28",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "SHERMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "866-776-5907"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2167801",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPH CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE",
            "identifier": "CLF-00353852",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2023; 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.