Irvine Pathology Medical Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

FNP19555 Issued in CA

Legal business name

IRVINE PATHOLOGY MEDICAL GROUP INC

Practice address

15375 Barranca Pkwy
Ste H-105
Irvine, CA 92618-2209

Phone

(949) 387-8111

Fax

(949) 387-6163

NPI assigned

Sep 25, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Alan M Rushovich, M.D.NPI 1629075882

Title

President

Phone

(949) 387-8111

Specialties & licenses 1

Addresses

Other identifiers 1

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

Practitioners 1

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

• Alan Michael Rushovich, M.D.

  • Specialist
  • Irvine, CA
  • NPI 1629075882
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1619077724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15375 BARRANCA PKWY",
            "address_2": "STE H-105",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182209",
            "telephone_number": "949-387-8111",
            "fax_number": "949-387-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15375 BARRANCA PKWY",
            "address_2": "STE H-105",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182209",
            "telephone_number": "949-387-8111",
            "fax_number": "949-387-6163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRVINE PATHOLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "RUSHOVICH",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-387-8111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "FNP19555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0057490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Irvine, CA
• Providers in Irvine, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; 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.