Brightstar Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

BRIGHTSTAR LAB

Practice address

4634 San Fernando Rd
Glendale, CA 91204

Phone

(747) 215-6633

NPI assigned

Jul 17, 2024

Organization subpart

No

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

Authorized official

Name

Ahsan Baseer, PHD., CLS

Title

Technical Supervisor

Phone

(714) 493-1224

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BRIGHTSTAR LAB Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

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

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1427896166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4634 SAN FERNANDO RD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91204",
            "telephone_number": "714-493-1224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4634 SAN FERNANDO RD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91204",
            "telephone_number": "747-215-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHTSTAR LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "BASEER",
        "authorized_official_first_name": "AHSAN",
        "authorized_official_title_or_position": "TECHNICAL SUPERVISOR",
        "authorized_official_telephone_number": "714-493-1224",
        "authorized_official_credential": "PHD., CLS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID",
            "identifier": "05D2304493",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRIGHTSTAR LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Glendale, CA
• Providers in Glendale, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.