NPIMap

Organization Active NPI

Loma Linda University Pathology Medical Group, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Murrieta, CA
National Provider Identifier
1659664654
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
05D2021238 Issued in CA
Legal business name
LOMA LINDA UNIVERSITY PATHOLOGY MEDICAL GROUP, INC.
Practice address
28062 Baxter Rd
Murrieta, CA 92563-1401
Phone
(951) 290-4580
Fax
(951) 290-4932
NPI assigned
May 24, 2011
Last updated
Dec 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Authorized official

Name
Mr. Paul Hermann, M.D.
Title
President
Phone
(909) 558-5175

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Blood Banking & Transfusion Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZB0001X 05D2021238 CA
Cytopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZC0500X 05D2021238 CA
Forensic Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZF0201X 05D2021238 CA
Hematology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZH0000X 05D2021238 CA
Medical Microbiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZM0300X 05D2021238 CA
Neuropathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZN0500X 05D2021238 CA
Molecular Genetic Pathology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0007X 05D2021238 CA
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X 05D2021238 CA Primary
Pediatric Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0213X 05D2021238 CA

Addresses

Primary practice location

28062 Baxter Rd
Murrieta, CA 92563-1401

Mailing address

PO Box 1740
Loma Linda, CA 92354-0240
Phone (909) 558-5170

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301000597 CA Part B Supplier - Clinic/Group Practice 1355234972 Receives reassigned benefits from 32 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Loma Linda, CA; Murrieta, CA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Loma Linda Univ Patholo3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

11370 Anderson St
Ste 2960
Loma Linda, CA 92354
Phone (909) 558-5175

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1659664654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1740",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923540240",
            "telephone_number": "909-558-5170",
            "fax_number": "909-793-8728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28062 BAXTER RD",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925631401",
            "telephone_number": "951-290-4580",
            "fax_number": "951-290-4932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOMA LINDA UNIVERSITY PATHOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-24",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "HERMANN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-558-5175",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        },
        {
            "code": "207ZF0201X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Forensic Pathology",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Hematology",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        },
        {
            "code": "207ZM0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Medical Microbiology",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        },
        {
            "code": "207ZN0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Neuropathology",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "05D2021238",
            "primary": true
        },
        {
            "code": "207ZP0213X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Pediatric Pathology",
            "state": "CA",
            "license": "05D2021238",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.