NPIMap

Organization Active NPI

University of the Pacific

Doing business as Pacific Oral & Maxillofacial Pathology Laboratory

  • Oral and Maxillofacial Pathology Dentistry
  • San Francisco, CA
National Provider Identifier
1407273279
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
Legal business name
UNIVERSITY OF THE PACIFIC
Doing business as
Pacific Oral & Maxillofacial Pathology Laboratory
Practice address
155 5TH St
Popl Suite 407E
San Francisco, CA 94103-2919
Phone
(415) 929-6560
Fax
(415) 929-6654
NPI assigned
Mar 18, 2014
Last updated
Jul 22, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
UNIVERSITY OF THE PACIFICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Authorized official

Name
Mr. Ed Pegueros
Title
Asst Dean, Budget & Fin Admin
Phone
(415) 351-7192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X NU Primary

Addresses

Primary practice location

155 5TH St
Popl Suite 407E
San Francisco, CA 94103-2919

Mailing address

155 5TH St
Popl Suite 407E
San Francisco, CA 94103-2919
Phone (415) 929-6560

Other identifiers 2

IdentifierTypeStateIssuer
CLF 00002594OtherCASTATE ID NUMBER
05D0643664OtherCACLIA NUMBER

Other names 2

  • Pacific Oral & Maxillofacial Pathology Laboratory Doing business as
  • Pacific Oral & Maxillofacial Pathology Laboratory, Arthur A. Dugoni School of Dentistry Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160608000993 CA Part B Supplier - Independent Clinical Laboratory 2163740861 Practice locations: San Francisco, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0643664Pacific Oral & Maxillofacial155 5TH St, Ste 412G, San Francisco, CA 94103ComplianceAug 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
University of the Pacific29 organizations share this tax ID, including this one
Part of
University of the Pacific

Other organizations with this tax ID 28

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

View all 28

Locations

155 5th St
Ste 407E
San Francisco, CA 94103
Phone (415) 929-6560

Practitioners & affiliated clinicians

Practitioners 1

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": "1395100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1407273279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 5TH ST",
            "address_2": "POPL SUITE 407E",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941032919",
            "telephone_number": "415-929-6560",
            "fax_number": "415-929-6654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 5TH ST",
            "address_2": "POPL SUITE 407E",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941032919",
            "telephone_number": "415-929-6560",
            "fax_number": "415-929-6654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF THE PACIFIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF THE PACIFIC",
        "enumeration_date": "2014-03-18",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "PEGUEROS",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "ASST DEAN, BUDGET & FIN ADMIN",
        "authorized_official_telephone_number": "415-351-7192",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID NUMBER",
            "identifier": "CLF 00002594",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "05D0643664",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Oral & Maxillofacial Pathology Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Oral & Maxillofacial Pathology Laboratory, Arthur A. Dugoni School of Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; 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.