NPIMap

Organization Active NPI

Vista Pathology Laboratory, LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Medford, OR
National Provider Identifier
1487928420
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
VISTA PATHOLOGY LABORATORY, LLC
Practice address
1032 E Jackson St
Medford, OR 97504-7027
Phone
(541) 770-4559
Fax
(541) 770-4511
NPI assigned
Mar 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Authorized official

Name
Mrs. Shari L Brite
Title
Administrator
Phone
54177044559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

1032 E Jackson St
Medford, OR 97504-7027

Mailing address

PO Box 1000
Medford, OR 97501-0071
Phone (541) 770-4559

Other identifiers 1

IdentifierTypeStateIssuer
38D2036013OtherORCLIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120522001339 OR Part B Supplier - Clinic/Group Practice 4587827985 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Gold Beach, OR; Grants Pass, OR; Medford, OR; Ashland, OR

Other NPIs on the same Medicare enrollment 1

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

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
38D2036013Vista Pathology Laboratory LLC1032 E Jackson Street, Medford, OR 97504AccreditationMar 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Vista Pathology Laboratory LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1487928420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975010071",
            "telephone_number": "541-770-4559",
            "fax_number": "541-770-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 E JACKSON ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047027",
            "telephone_number": "541-770-4559",
            "fax_number": "541-770-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA PATHOLOGY LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "BRITE",
        "authorized_official_first_name": "SHARI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "54177044559",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "38D2036013",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; 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.