PVCH Clinical Laboratory Medical Group Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

PVCH CLINICAL LABORATORY MEDICAL GROUP INC

Practice address

1798 N. Garey Ave
Pomona Valley, CA 91767-2918

Phone

(909) 865-9500

Fax

(419) 866-5453

NPI assigned

Feb 26, 2007

Last updated

Dec 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Nasca, MDNPI 1508887969

Title

President

Phone

(909) 865-9824

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Catherine Chang-Suen, D.O.

  • Anatomic Pathology & Clinical Pathology Physician
  • Pomona, CA
  • NPI 1205201621

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Victor J Santiago, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Pomona, CA
  • NPI 1851711568
  Medicare reassignment Care Compare group NPD
• Philip O Strassle, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Pomona, CA
  • NPI 1952320699
  Medicare reassignment Care Compare group
• David Nasca, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Pomona, CA
  • NPI 1508887969
  Authorized official Same address or phone
• Paul A Reisch, MD

  • Diagnostic Radiology Physician
  • Pomona, CA
  • NPI 1871576363
  NPD

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671667200000",
    "number": "1235265851",
    "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": "1798 N. GAREY AVE",
            "city": "POMONA VALLEY",
            "state": "CA",
            "postal_code": "917672918",
            "telephone_number": "909-865-9500",
            "fax_number": "419-866-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PVCH CLINICAL LABORATORY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A",
        "authorized_official_last_name": "NASCA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-865-9824",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091610",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ39226Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.