NPIMap

Organization Active NPI

Western Laboratories

Doing business as Western Laboratory Medical Group

  • Anatomic Pathology & Clinical Pathology Physician
  • Fremont, CA
National Provider Identifier
1255393435
Registry record updated Jan 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
WESTERN LABORATORIES
Doing business as
Western Laboratory Medical Group
Practice address
2000 Mowry Ave
Fremont, CA 94538-1716
Phone
(510) 797-1111
NPI assigned
Apr 4, 2006
Last updated
Jan 8, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2014

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

Authorized official

Name
Clifford Tschetter, MDNPI 1518929108
Title
Managing Partner
Phone
(510) 797-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X Primary

Addresses

Primary practice location

2000 Mowry Ave
Fremont, CA 94538-1716

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
GR0014623MedicaidCA

Other names 1

  • Western Laboratory Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031210000669 CA Part B Supplier - Clinic/Group Practice 2769388776 Receives reassigned benefits from 8 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alameda, CA; Fremont, CA; Hayward, CA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Western Laboratories3 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.

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1255393435",
    "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": "2000 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381716",
            "telephone_number": "510-797-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN LABORATORIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "TSCHETTER",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "510-797-1111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0014623",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Laboratory Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.