Active NPI
Jay Packer, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Fullerton, CA
National Provider Identifier
1821033150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- G42128
- Practice address
- 101 E. Valencia Mesa Drive
Pathology Dept
Fullerton, CA 92835 - Phone
- (714) 992-3907
- Fax
- (714) 992-3055
- NPI assigned
- Jun 19, 2006
- Last updated
- Feb 6, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | G42128 | CA | Primary |
Addresses
Primary practice location
101 E. Valencia Mesa Drive
Pathology Dept
Fullerton, CA 92835
Mailing address
PO Box 749421
Los Angeles, CA 90074-9421
Phone (310) 225-3244
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G421280 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G42128 | CA | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Vincent Anesthesia Medical Group, Inc. | Past | Accepting new patients | |
| California Em-I Medical Services, a Medical Corporation | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Los Alamitos, CA
- NPI 1477502615
-
- Anesthesiology Physician
- Los Angeles, CA
- NPI 1164535571
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233878400000",
"number": "1821033150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 749421",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900749421",
"telephone_number": "310-225-3244",
"fax_number": "310-698-7054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E. VALENCIA MESA DRIVE",
"address_2": "PATHOLOGY DEPT",
"city": "FULLERTON",
"state": "CA",
"postal_code": "92835",
"telephone_number": "714-992-3907",
"fax_number": "714-992-3055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACKER",
"first_name": "JAY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-19",
"last_updated": "2009-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "CA",
"license": "G42128",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G421280",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.