NPIMap

Organization Active NPI

Associated Pathology Medical Group, Inc

  • Clinical Medical Laboratory
  • Santa Cruz, CA
National Provider Identifier
1679659114
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
05D0606603 Issued in CA
Legal business name
ASSOCIATED PATHOLOGY MEDICAL GROUP, INC
Practice address
1555 Soquel Dr
Santa Cruz, CA 95065-1705
Phone
(408) 884-2710
Fax
(408) 884-2734
NPI assigned
Oct 27, 2006
Last updated
Jun 24, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
ASSOCIATED PATHOLOGY MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Authorized official

Name
Elizabeth Ann Sandoval
Title
Billing Manager
Phone
(408) 884-2710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 05D0606603 CA Primary

Addresses

Primary practice location

1555 Soquel Dr
Santa Cruz, CA 95065-1705

Mailing address

PO Box 665
Los Gatos, CA 95031-0665
Phone (408) 884-2710

Other identifiers 3

IdentifierTypeStateIssuer
GR0088851MedicaidCA
Q682OtherCASAN FRANCISCO HEALTH PLAN
CS1327OtherCAMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050518001205 CA Part B Supplier - Clinic/Group Practice 0143261214 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Gatos, CA; Santa Cruz, 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
Associated Pathology Medical Group2 organizations share this tax ID, including this one
Part of
Associated Pathology Medical Group

Other organizations with this tax ID 1

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

Locations

105A Cooper Ct
Los Gatos, CA 95032
Phone (408) 884-2710

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1679659114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 665",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950310665",
            "telephone_number": "408-884-2710",
            "fax_number": "408-884-2734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SOQUEL DR",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651705",
            "telephone_number": "408-884-2710",
            "fax_number": "408-884-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED PATHOLOGY MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ASSOCIATED PATHOLOGY MEDICAL GROUP",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "SANDOVAL",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "408-884-2710"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D0606603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0088851",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAN FRANCISCO HEALTH PLAN",
            "identifier": "Q682",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CS1327",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.