Organization Active NPI

Sequenom Center for Molecular Medicine LLC

Clinical Medical Laboratory
San Diego, CA

National Provider Identifier

1730481078

Registry record updated Jul 20, 2017

On this page

Key facts
NPPES NPI Registry
Medicare participation
Laboratory certificates & supplier records
National Provider Directory
NPI Registry JSON
Other providers in San Diego, CA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical Medical LaboratoryTaxonomy code 291U00000X
License: CLF00339964 Issued in CA
Legal business name: SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC
Doing business as: Sequenom Laboratories
Practice address: 3595 John Hopkins CT
San Diego, CA 92121-1121
Phone: (858) 202-9051
Fax: (858) 408-7847
NPI assigned: Nov 18, 2010
Organization subpart: Yes
Parent organization: SEQUENOM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2017

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

Authorized official

Name: Kimberly T Williams
Title: Vice President
Phone: (800) 222-7566

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Clinical Medical Laboratory	291U00000X	CLF00339964	CA	Primary

Addresses

Primary practice location

3595 John Hopkins CT
San Diego, CA 92121-1121

Mailing address

3595 John Hopkins CT
San Diego, CA 92121-1121
Phone (858) 202-9051

Other identifiers 50

Identifier	Type	State	Issuer
003115419A	Medicaid	GA
05D2015356	Other	CA	CLIA
1020915	Medicaid	VT
102377695-002	Medicaid	PA
1728	Other	MD	MARYLAND MEDICAL LABORATORY PERMIT
1730481078	Medicaid	WY
1730481078	Medicaid	MI
800026127	Other	FL	STATE OF FLORIDA CLINICAL LABORATORY LICENSE
1527595	Medicaid	TN
1730481078	Medicaid	MN
200311320B	Medicaid	OK
2017818	Medicaid	WA
2192639	Medicaid	LA
7100190660	Medicaid	KY
7527138	Other		COLLEGE OF AMERICAN PATHOLOGISTS (CAP)
770365889-002	Medicaid	IL
92038026	Medicaid	CO
L00343	Medicaid	SC
032136	Other	PA	STATE OF PENNSYLVANIA CLINICAL LABORATORY LICENSE
1730481078	Medicaid	ME
3708683	Medicaid	NY
71028300	Medicaid	DC
PFI: 8557	Other	NY	STATE OF NEW YORK CLINICAL LABORATORY PERMIT
1730481078	Medicaid	IA
1730481078	Medicaid	UT
200656570 B	Medicaid	KS
4192451 01	Medicaid	MD
10026203300	Medicaid	NE
137226	Medicaid	AL
1730481078	Medicaid	ID
30809688	Medicaid	NH
7001452	Medicaid	NC
CLF00339964	Other	CA	CLINICAL LABORATORY LICENSE
LB011CA	Medicaid	AK
3810023520	Medicaid	WV
004122500	Medicaid	FL
1730481078	Medicaid	VA
1730481078	Medicaid	MO
1730481078	Medicaid	CT
20123744	Medicaid	NM
296651	Medicaid	NJ
323717401	Medicaid	TX
6231868	Medicaid	MS
660597	Medicaid	AZ
0056345	Medicaid	OH
100022595	Medicaid	WI
1730481078	Medicaid	MT
200958790 B	Medicaid	IN
FV093A	Other	CA	MEDICARE PTAN
LCO 00657	Other	RI	RHODE ISLAND CLINICAL LABORATORY LICENSE

Other names 1

Sequenom Laboratories Doing business as

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in CA

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20120313000563	CA	Part B Supplier - Independent Clinical Laboratory	4688731227	Practice locations: San Diego, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
05D2015356	Sequenom Center for Molecular Medicine, LLC3595 John Hopkins Court, San Diego, CA 92121	Accreditation	Aug 22, 2027

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Laboratory Corporation of America Holdings
- Clinical Medical Laboratory
- Cromwell, CT
- NPI 1700517984
Member Of
NPD member

Locations

3595 John Hopkins Ct
San Diego, CA 92121
Phone (858) 202-9051

1912 Tw Alexander Dr
Rtp, NC 27709
Phone (800) 533-0567

Networks

Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

NPI Registry JSON

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500508800000",
    "number": "1730481078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3595 JOHN HOPKINS CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211121",
            "telephone_number": "858-202-9051",
            "fax_number": "858-408-7847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
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            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211121",
            "telephone_number": "858-202-9051",
            "fax_number": "858-408-7847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEQUENOM CENTER FOR MOLECULAR MEDICINE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEQUENOM INC",
        "enumeration_date": "2010-11-18",
        "last_updated": "2017-07-20",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT",
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    },
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        {
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            "taxonomy_group": "",
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    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sequenom Laboratories",
            "code": "3",
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        }
    ]
}

Other providers in San Diego, CA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.