Medical Diagnostic Laboratories,LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MEDICAL DIAGNOSTIC LABORATORIES,LLC

Practice address

8238 S Madison St
Burr Ridge, IL 60527-5811

Phone

(630) 560-0536

Fax

(630) 560-0120

NPI assigned

Nov 3, 2022

Organization subpart

Yes

Parent organization

MEDICAL DIAGNOSTIC LABORATORIES, LLCAs reported in NPPES

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

Authorized official

Name

Milissa Earnest

Title

Revenue Manager

Phone

(609) 528-6613

Specialties & licenses 1

Addresses

Other names 1

• MDL-IL Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Medical Diagnostic Laboratories,LLC

  • Clinical Medical Laboratory
  • Hamilton, NJ
  • NPI 1750373908

  8123006277

  Same PAC ID

Tax ID family

Medical Diagnostic2 organizations share this tax ID, including this one

Part of

Medical Diagnostic

Other organizations with this tax ID 1

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

• Medical Diagnostic Laboratories,LLC

  • Clinical Medical Laboratory
  • Hamilton, NJ
  • NPI 1750373908
  NPD tax ID

Practitioners 1

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

• Ling Gao

  • Molecular Genetic Pathology (Pathology) Physician
  • Burr Ridge, IL
  • NPI 1457797300
  NPD

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

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1659088185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2439 KUSER RD",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086903303",
            "telephone_number": "609-269-0090",
            "fax_number": "609-570-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8238 S MADISON ST",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275811",
            "telephone_number": "630-560-0536",
            "fax_number": "630-560-0120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL DIAGNOSTIC LABORATORIES,LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDICAL DIAGNOSTIC LABORATORIES, LLC",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "EARNEST",
        "authorized_official_first_name": "MILISSA",
        "authorized_official_title_or_position": "REVENUE MANAGER",
        "authorized_official_telephone_number": "609-528-6613"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MDL-IL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Melissa McCroy
• David McDermott
• Cara Lyn McGuire, FNP
• Taylor Alise McIntire
• Megan Leigh McMillin, M.S., SLP
• Jennifer Mehlman, MA CCC-SLP
• Aarti Mehta
• Julie Mekhail
• David O Meltzer, MD
• Janis Mendelsohn, MD

• Clinical Medical Laboratory in Burr Ridge, IL
• Providers in Burr Ridge, IL by specialty
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.