NPIMap

Organization Active NPI

County of Santa Cruz

  • Clinical Medical Laboratory
  • Santa Cruz, CA
National Provider Identifier
1740329515
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
01284F Issued in CA
Legal business name
COUNTY OF SANTA CRUZ
Practice address
1080 Emeline Ave
Laboratory
Santa Cruz, CA 95060
Phone
(831) 454-5445
Fax
(831) 454-5000
NPI assigned
Feb 6, 2007
Organization subpart
Yes
Parent organization
COUNTY OF SANTA CRUZAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Authorized official

Name
Ms. Amy Peeler
Title
Chief of Clinics
Phone
(831) 454-4764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 01284F CA Primary

Addresses

Primary practice location

1080 Emeline Ave
Laboratory
Santa Cruz, CA 95060

Mailing address

1080 Emeline Ave
Laboratory
Santa Cruz, CA 95060
Phone (831) 454-5445

Other identifiers 3

IdentifierTypeStateIssuer
HAP70042FOtherCACA. FAMILY PLANNING
05D0063277OtherCMSCLIA
LAB01284FMedicaidCA

Other names 1

  • Health Services Agency Laboratory Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080502000340 CA Part B Supplier - Independent Clinical Laboratory 7618872912 2 other NPIs on this enrollment
Practice locations: Santa Cruz, CA; Watsonville, CA

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

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 numberLaboratoryCertificateExpires
05D0902998Santa Cruz County1080 Emeline Ave, Santa Cruz, CA 95060Certificate of waiverJun 19, 2028

National Provider Directory

National Provider Directory
Part of
Puentes Al Sur

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
County of Santa CruzSanta Cruz, CA, CCN 751075 Federally qualified health center Operational/Managerial Control (100%) May 1, 2014
County of Santa CruzWatsonville, CA, CCN 751076 Federally qualified health center Operational/Managerial Control (100%) May 1, 2014

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1740329515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "address_2": "LABORATORY",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "95060",
            "telephone_number": "831-454-5445",
            "fax_number": "831-454-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "address_2": "LABORATORY",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "95060",
            "telephone_number": "831-454-5445",
            "fax_number": "831-454-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SANTA CRUZ",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SANTA CRUZ",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "PEELER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CHIEF OF CLINICS",
        "authorized_official_telephone_number": "831-454-4764",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "01284F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA. FAMILY PLANNING",
            "identifier": "HAP70042F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMSCLIA",
            "identifier": "05D0063277",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB01284F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Services Agency Laboratory",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Health Services Agency Laboratory",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.