NPIMap

Organization Active NPI

Yale University

Doing business as Yale Dermatopathology Lab

  • Clinical Medical Laboratory
  • New Haven, CT
National Provider Identifier
1922042258
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
YALE UNIVERSITY
Doing business as
Yale Dermatopathology Lab
Practice address
15 York St
New Haven, CT 06510-3221
Phone
(203) 785-4094
Fax
(203) 785-6414
NPI assigned
Jun 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Marianne Dess-Santoro
Title
Chief Operating Officier
Phone
(203) 785-2140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

15 York St
New Haven, CT 06510-3221

Mailing address

300 George St
PO Box 9805
New Haven, CT 06511-6624
Phone (203) 785-7998

Other identifiers 1

IdentifierTypeStateIssuer
00413468MedicaidCT

Other names 1

  • YALE DERMATOPATHOLOGY LAB Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060620000151 CT Part B Supplier - Independent Clinical Laboratory 9436061736 Practice locations: New Haven, CT

Other NPIs with the same Medicare PAC ID 11

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

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
07D0099096Yale Dermatopathology Laboratory15 York Street LMP-5031, New Haven, CT 06510AccreditationDec 9, 2027
07D1029020State of Connecticut Biodosimetry Laboratory15 York St, New Haven, CT 06510ComplianceMar 5, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Mga HomecareScottsdale, AZ, CCN 037243 Home health agency 5% Or Greater Indirect Ownership Interest (11.05%) Feb 12, 2020
Mga HomecareColorado Springs, CO, CCN 067487 Home health agency 5% Or Greater Indirect Ownership Interest (11.05%) Feb 12, 2020
Mga HomecareGlendale, CO, CCN 067522 Home health agency 5% Or Greater Indirect Ownership Interest (11.05%) Feb 12, 2020
Mga HomecareAustin, TX, CCN 748009 Home health agency 5% Or Greater Indirect Ownership Interest (11.05%) Feb 12, 2020
Mga HomecarePueblo, CO, CCN 067584 Home health agency 5% Or Greater Indirect Ownership Interest (11.05%) Feb 12, 2020
Mga HomecareAddison, TX, CCN 748028 Home health agency 5% Or Greater Indirect Ownership Interest (11.05%) Feb 12, 2020
Mga HomecareMemphis, TN, CCN 447825 Home health agency 5% Or Greater Indirect Ownership Interest (11.05%) Feb 4, 2022

Owned or controlled facilities with NPI records 9

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": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922042258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 GEORGE ST",
            "address_2": "PO BOX 9805",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065116624",
            "telephone_number": "203-785-7998",
            "fax_number": "203-785-6414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103221",
            "telephone_number": "203-785-4094",
            "fax_number": "203-785-6414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YALE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DESS-SANTORO",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICIER",
        "authorized_official_telephone_number": "203-785-2140"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00413468",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "YALE DERMATOPATHOLOGY LAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.