NPIMap

Organization Active NPI

Saint Agnes Pathology Medical Group

  • Clinical Pathology/Laboratory Medicine Physician
  • Fresno, CA
National Provider Identifier
1700804689
Registry record updated Mar 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
Legal business name
SAINT AGNES PATHOLOGY MEDICAL GROUP
Practice address
1303 E. Herndon Avenue
Fresno, CA 93720-3309
Phone
(559) 450-3130
Fax
(559) 450-2035
NPI assigned
Jul 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2016

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

Authorized official

Name
Wei Fang, M.D.NPI 1043231814
Title
Authorized Official
Phone
(559) 430-3130

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0105X Primary

Addresses

Primary practice location

1303 E. Herndon Avenue
Fresno, CA 93720-3309

Mailing address

P.O. Box 3246
Pinedale, CA 93350-3246
Phone (559) 450-3130

Other identifiers 1

IdentifierTypeStateIssuer
GR0041880MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070502000688 CA Part B Supplier - Clinic/Group Practice 5597861880 Receives reassigned benefits from 5 practitioners
Practice locations: Fresno, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458864000000",
    "number": "1700804689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 3246",
            "city": "PINEDALE",
            "state": "CA",
            "postal_code": "933503246",
            "telephone_number": "559-450-3130",
            "fax_number": "559-450-2035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 E. HERNDON AVENUE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203309",
            "telephone_number": "559-450-3130",
            "fax_number": "559-450-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT AGNES PATHOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2016-03-25",
        "status": "A",
        "authorized_official_last_name": "FANG",
        "authorized_official_first_name": "WEI",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "559-430-3130",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0041880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; 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.