Skylinedx USA Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SKYLINEDX USA INC.

Practice address

3030 Bunker Hill St Ste 230
San Diego, CA 92109-5757

Phone

(858) 886-7907

NPI assigned

Sep 24, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Pim Van Bruggen, MBA

Title

Executive VP, Finance, HR & Legal

Phone

(010) 720-0313

Specialties & licenses 1

Addresses

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": "1600905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1609483510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 BUNKER HILL ST STE 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921095757",
            "telephone_number": "858-886-7907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 BUNKER HILL ST STE 230",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921095757",
            "telephone_number": "858-886-7907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINEDX USA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-24",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "VAN BRUGGEN",
        "authorized_official_first_name": "PIM",
        "authorized_official_title_or_position": "EXECUTIVE VP, FINANCE, HR & LEGAL",
        "authorized_official_telephone_number": "010-720-0313",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in San Diego, CA
• Providers in San Diego, 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 Dec 16, 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.