Active NPI
State of Delaware
- Clinical Medical Laboratory
- Dover, DE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- STATE OF DELAWARE
- Practice address
- 417 Federal St
Dover, DE 19901-3635 - Phone
- (302) 744-4548
- Fax
- (302) 739-1613
- NPI assigned
- Nov 15, 2006
- Last updated
- Dec 1, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Karyl Rattay, MD
- Title
- Director
- Phone
- (302) 744-4700
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
417 Federal St
Dover, DE 19901-3635
Mailing address
417 Federal St
Dover, DE 19901-3635
Phone (302) 744-4548
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000160809 | Medicaid | DE |
Other names 1
- DPH Lab
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040319000575 | DE | Part B Supplier - Clinic/Group Practice | 6507756731 |
Receives reassigned benefits from 7 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Dover, DE; Smyrna, DE |
| O20231121000035 | DE | Part B Supplier - Independent Clinical Laboratory | 6507756731 | Practice locations: Smyrna, DE |
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Kent/Sussex Community Mental Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Dover, DE
- NPI 1104871920
6507756731
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba NC Community Mental Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Wilmington, DE
- NPI 1609895762
O20040319000575
-
dba Kent/Sussex Community Mental Health Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Dover, DE
- NPI 1104871920
O20040319000575
-
- Intellectual Disabilities Intermediate Care Facility
- Georgetown, DE
- NPI 1558417683
O20040319000575
National Provider Directory
National Provider DirectoryOwnership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Delaware Hospital F/T Chronically Ill | Skilled nursing facility | Adp of the SNF Indirect Ownership Interest (1%) |
Sep 1, 1983 Sep 1, 1983 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Skilled Nursing Facility
- Smyrna, DE
- NPI 1538123583
Adp of the SNF, Indirect Ownership Interest
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pediatrics Physician
- Dover, DE
- NPI 1124216585
-
- Internal Medicine Physician
- Newark, DE
- NPI 1114130069
-
- Ambulatory Family Planning Facility
- Dover, DE
- NPI 1326171067
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1322697600000",
"number": "1922170703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "417 FEDERAL ST",
"city": "DOVER",
"state": "DE",
"postal_code": "199013635",
"telephone_number": "302-744-4548",
"fax_number": "302-739-1613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 FEDERAL ST",
"city": "DOVER",
"state": "DE",
"postal_code": "199013635",
"telephone_number": "302-744-4548",
"fax_number": "302-739-1613"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STATE OF DELAWARE",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2011-12-01",
"status": "A",
"authorized_official_last_name": "RATTAY",
"authorized_official_first_name": "KARYL",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "302-744-4700",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000160809",
"state": "DE"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "DPH Lab",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Dover, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.