El Dorado Pathology Medical Group, Inc

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

204723 Issued in CA

Legal business name

EL DORADO PATHOLOGY MEDICAL GROUP, INC

Practice address

1000 Fowler Way
Ste 4
Placerville, CA 95667-5738

Phone

(530) 626-5421

Fax

(530) 626-4265

NPI assigned

Jun 24, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Michael C Berry, M.D.

Title

President

Phone

(530) 626-5421

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stanley Kwong, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Placerville, CA
  • NPI 1770999088
  NPD
• John R Claiche, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Placerville, CA
  • NPI 1669478426
  NPD (past)

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609977600000",
    "number": "1942206719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 FOWLER WAY",
            "address_2": "STE 4",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675738",
            "telephone_number": "530-626-5421",
            "fax_number": "530-626-4265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 FOWLER WAY",
            "address_2": "STE 4",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675738",
            "telephone_number": "530-626-5421",
            "fax_number": "530-626-4265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL DORADO PATHOLOGY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "530-626-5421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "204723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• El Dorado County Public Health Laboratory
• El Dorado County TCM Program
• El Dorado County, Department of Human Services
• El Dorado Hearing Center, Inc.
• El Dorado Mental Health
• El Dorado Recovery Center, LLC
• El Dorado Surgery Center LLC
• El Dorado Surgery Center, Inc.
• El Dorado Union School District
• Elder Options, Inc.

• Anatomic Pathology & Clinical Pathology Physician in Placerville, CA
• Providers in Placerville, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; 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.