NPIMap

Organization Active NPI

Ambry Genetics Corporation

  • Clinical Medical Laboratory
  • Aliso Viejo, CA
National Provider Identifier
1861568784
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
AMBRY GENETICS CORPORATION
Practice address
7 Argonaut
Aliso Viejo, CA 92656-1423
Phone
(949) 900-5500
Fax
(949) 900-5501
NPI assigned
Nov 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Authorized official

Name
Michael Raymond Martinson
Title
Cfo
Phone
(949) 900-5585

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X CLF11694 CA
Clinical Medical Laboratory 291U00000X CA Primary

Addresses

Primary practice location

7 Argonaut
Aliso Viejo, CA 92656-1423

Mailing address

1 Enterprise
Aliso Viejo, CA 92656-2606
Phone (949) 457-4143

Other identifiers 34

IdentifierTypeStateIssuer
0421379MedicaidMT
1024063580001MedicaidPA
1061577MedicaidWA
419149800MedicaidMD
462462900MedicaidMN
7100029600MedicaidKY
L00282MedicaidSC
1517245MedicaidTN
15197MedicaidND
200034590AMedicaidOK
453277016MedicaidMI
7154701OtherCALAP CAP
806650800MedicaidID
0054976MedicaidNJ
010127904MedicaidVA
10025004600MedicaidNE
1006834MedicaidAK
200967250AMedicaidIN
212446302MedicaidTX
69584834MedicaidCO
797178MedicaidAZ
157113709MedicaidAR
003151337AMedicaidGA
1017246MedicaidVT
2958381MedicaidNY
86759825MedicaidNM
9880101-000MedicaidWV
1464660MedicaidLA
212446301MedicaidTX
690000008MedicaidAL
LAB81414FMedicaidCA
200267720AMedicaidKS
2418146MedicaidOH
775960MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031217001138 CA Part B Supplier - Independent Clinical Laboratory 7416854385 1 other NPI on this enrollment
Practice locations: Aliso Viejo, 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 numberLaboratoryCertificateExpires
05D0981414Ambry Genetics7 Argonaut, Aliso Viejo, CA 92656AccreditationMay 29, 2028

National Provider Directory

National Provider Directory

Locations

100 Columbia
Ste 200
Aliso Viejo, CA 92656
Phone (949) 900-5500

15 Argonaut
Aliso Viejo, CA 92656
Phone (949) 900-5500

1 Enterprise
Aliso Viejo, CA 92656
Phone (949) 900-5500

2060 Placentia Ave
Ste A5
Costa Mesa, CA 92627
Phone (949) 642-7202

100 Technology Dr
Irvine, CA 92618
Phone (949) 306-6288

Practitioners & affiliated clinicians

Practitioners 5

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": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724284800000",
    "number": "1861568784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ENTERPRISE",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926562606",
            "telephone_number": "949-457-4143",
            "fax_number": "949-900-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 ARGONAUT",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926561423",
            "telephone_number": "949-900-5500",
            "fax_number": "949-900-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMBRY GENETICS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-900-5585"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF11694",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
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        },
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    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aliso Viejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.