NPIMap

Organization Active NPI

Long Beach Memorial Pathology Medical Group, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Long Beach, CA
National Provider Identifier
1942257191
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
LONG BEACH MEMORIAL PATHOLOGY MEDICAL GROUP, INC.
Practice address
2801 Atlantic Ave
Department of Pathology
Long Beach, CA 90806-1701
Phone
(562) 933-0717
Fax
(562) 933-0791
NPI assigned
May 30, 2006
Last updated
Dec 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

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

Authorized official

Name
Dr. Lisa Shane, MDNPI 1316905235
Title
Vice Pres. Treasurer
Phone
(562) 933-0713

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary

Addresses

Primary practice location

2801 Atlantic Ave
Department of Pathology
Long Beach, CA 90806-1701

Mailing address

2801 Atlantic Ave
Department of Pathology
Long Beach, CA 90806-1701
Phone (562) 933-0717

Other identifiers 3

IdentifierTypeStateIssuer
ZZZ96712ZOtherCABLUE SHIELD
GR0049700MedicaidCA
ZZZ05043ZOtherCABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050302000982 CA Part B Supplier - Clinic/Group Practice 8426001363 Receives reassigned benefits from 12 practitioners
Practice locations: Fountain Valley, CA; Long Beach, CA

National Provider Directory

National Provider Directory
Tax ID family
Long Beach Mem Path Med3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2801 Atlantic Ave
Fl Specialty
Long Beach, CA 90806
Phone (562) 933-8749

1801 W Olympic Blvd
#1319
Pasadena, CA 91199

File 13191801 W Olympic Blvd
Pasadena, CA 91199

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 & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1942257191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 ATLANTIC AVE",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061701",
            "telephone_number": "562-933-0717",
            "fax_number": "562-933-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 ATLANTIC AVE",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061701",
            "telephone_number": "562-933-0717",
            "fax_number": "562-933-0791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG BEACH MEMORIAL PATHOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "SHANE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "VICE PRES. TREASURER",
        "authorized_official_telephone_number": "562-933-0713",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ96712Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0049700",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ05043Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.