NPIMap

Organization Active NPI

Neogenomics Laboratories Inc

  • Clinical Medical Laboratory
  • Tustin, CA
National Provider Identifier
1639793615
Registry record updated Jan 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
NEOGENOMICS LABORATORIES INC
Practice address
15527 Cardamon Way
Tustin, CA 92782-1911
Phone
(866) 776-5907
Fax
(888) 443-4153
NPI assigned
Jun 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2023

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

Authorized official

Name
Jeffrey Scott Sherman
Title
Cfo
Phone
(866) 776-5907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

15527 Cardamon Way
Tustin, CA 92782-1911

Mailing address

31 Columbia
Aliso Viejo, CA 92656-1460
Phone (866) 776-5907

Other identifiers 2

IdentifierTypeStateIssuer
05D2183172OtherCACLIA
CLF90000729OtherCACLINICAL AND PUBLIC HEALTH LABORATORY LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071116000642 CA Part B Supplier - Independent Clinical Laboratory 7113011172 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aliso Viejo, CA; Carlsbad, CA; Fresno, CA; San Diego, CA; Sierra Madre, CA

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672963200000",
    "number": "1639793615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 COLUMBIA",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926561460",
            "telephone_number": "866-776-5907",
            "fax_number": "888-443-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15527 CARDAMON WAY",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927821911",
            "telephone_number": "866-776-5907",
            "fax_number": "888-443-4153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEOGENOMICS LABORATORIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-04",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "SHERMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "866-776-5907"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D2183172",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE",
            "identifier": "CLF90000729",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.