NPIMap

Organization Active NPI

Pacific Pathology Medical Group Inc

  • Anatomic Pathology Physician
  • Inglewood, CA
National Provider Identifier
1609953736
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
Legal business name
PACIFIC PATHOLOGY MEDICAL GROUP INC
Practice address
555 E Hardy St
Pathology Department
Inglewood, CA 90301
Phone
(310) 680-8391
Fax
(310) 412-4501
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Willard Frank Worthen II, MDNPI 1235205253
Title
President
Phone
(310) 680-8391

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0101X Primary

Addresses

Primary practice location

555 E Hardy St
Pathology Department
Inglewood, CA 90301

Mailing address

555 E Hardy St
Department of Pathology
Inglewood, CA 90301
Phone (310) 680-8391

Other identifiers 2

IdentifierTypeStateIssuer
GR0045861MedicaidCA
GR0045860MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609953736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E HARDY ST",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "90301",
            "telephone_number": "310-680-8391",
            "fax_number": "310-412-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E HARDY ST",
            "address_2": "PATHOLOGY DEPARTMENT",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "90301",
            "telephone_number": "310-680-8391",
            "fax_number": "310-412-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC PATHOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WORTHEN",
        "authorized_official_first_name": "WILLARD",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-680-8391",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0045861",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0045860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.