Indian River Pathology LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

ME46694 Issued in FL

Legal business name

INDIAN RIVER PATHOLOGY LLC

Practice address

6696 S US Highway 1
Port St Lucie, FL 34952-1423

Phone

(772) 466-6651

Fax

(772) 466-0662

NPI assigned

Mar 24, 2006

Organization subpart

No

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

Authorized official

Name

Shelly M Robinson

Title

Revenue Cycle/Credentialing Manager

Phone

(770) 490-5009

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hung-Wei Lee, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Bradenton, FL
  • NPI 1871628529
  Medicare reassignment Care Compare group NPD
• Drazen M Jukic, MD, PHD

  • Dermatopathology (Pathology) Physician
  • Savannah, GA
  • NPI 1134193774

  FL

  Medicare reassignment Care Compare group NPD
• Anil Desai, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Port St Lucie, FL
  • NPI 1013942556
  Medicare reassignment NPD
• Uzma Farooq, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Miami, FL
  • NPI 1467617506
  NPD (past)
• Daniel Gonzalez

  • Dermatopathology (Pathology) Physician
  • Coral Gables, FL
  • NPI 1336672716
  NPD (past)
• Veronica Gennadievna Papavero, M.D.

  • Anatomic Pathology Physician
  • Fort Myers, FL
  • NPI 1568621704
  NPD (past)
• Jacqueline Jaudon Russo, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Gainesville, FL
  • NPI 1316028376
  NPD (past)
• Lynn D Cooper, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Marietta, GA
  • NPI 1366658437
  NPD (past)
• Sheva Khalafbeigi, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Lexington, MA
  • NPI 1114456407
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1477513323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 881016",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349881016",
            "telephone_number": "772-466-6651",
            "fax_number": "772-466-0662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6696 S US HIGHWAY 1",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349521423",
            "telephone_number": "772-466-6651",
            "fax_number": "772-466-0662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN RIVER PATHOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REVENUE CYCLE/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "770-490-5009"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "ME46694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252482100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "41580",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matilda Chimezie Ike, DR. (DNP)
• Diana Lopez Ilarraza
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• Evelina Ingersoll, ARNP
• Keith E Ingram, M.D.

• Clinical Medical Laboratory in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; 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.