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DIAGNOSTIC PATHOLOGY MEDICAL GROUP INC
NPI 1023673167
Pathology - Anatomic Pathology & Clinical Pathology in Lodi, CA

Active since May 03, 2019CLIA 05D2101404 · Accreditation
975 S FAIRMONT AVE, LODI, CA 95240(916) 447-6267(916) 456-5842 Get Directions Write a Review

NPPES record last updated: May 3, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Diagnostic Pathology Medical Group Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIAGNOSTIC PATHOLOGY MEDICAL GROUP INC (NPI 1023673167) is a healthcare organization registered as an anatomic pathology & clinical pathology in Lodi, California and active in the NPI registry since May 2019. The organization holds an CLIA Accreditation certificate valid through April 25, 2027 and lists Derek K Marsee, President, as its authorized official.

NPPES Registry Identity

NPI1023673167
Entity TypeOrganization
Primary Taxonomy207ZP0102X
Legal Business NameDIAGNOSTIC PATHOLOGY MEDICAL GROUP INC
Location Address975 S FAIRMONT AVELodi, CA 95240-5118
Mailing Address3301 C St Ste 200eSacramento, CA 95816-3363 · (916) 447-6267 · Fax (916) 456-5842
Phone(916) 447-6267
Fax(916) 456-5842
Organization SubpartNo
Authorized OfficialDerek K MarseePresident · (916) 447-6267
Enumeration DateMay 3, 2019
✔ NPI 1023673167 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ZP0102X
Definition
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
975 S FAIRMONT AVE, Lodi, CA 95240
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Diagnostic Pathology Medical Group Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20040427001740Non-DME Part B · Clinic/Group PracticeDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

38

Medicare enrollment records show 38 clinicians reassign Medicare billing to Diagnostic Pathology Medical Group Inc, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. Listed here are the 20 practicing nearest to this location.

Nearest to this location (20)

See all 38
Elvira Milano, M.D.
Pathology
NPI 1558339119
975 S FAIRMONT AVE CONRAD BUILDING
Lodi, CA 95240
(209) 339-7585
✔ PECOS0.1 mi
Han Lee, MD., PHD
Pathology
NPI 1134457708
4400 V ST
Sacramento, CA 95817
(916) 734-8331
✔ PECOS✔ Accepts Medicare32 mi
Kristen Vandewalker, M.D.
Pathology
NPI 1124070743
3301 C ST SUITE 200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS32 mi
Jonathan Konopinski
Pathology
NPI 1629497185
3301 C ST STE 200E
Sacramento, CA 95816
(800) 465-3203
✔ PECOS✔ Accepts Medicare33 mi
Long Li, M.D.
Pathology
NPI 1740625102
3301 C ST STE 200E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare33 mi
Andrea Ong, M.D.
Pathology
NPI 1902826472
3301 C ST SUITE #200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare33 mi
Juan Rong
Pathology
NPI 1821403049
3301 C ST STE 200E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare33 mi
Sasan Setoodeh
Pathology
NPI 1710373147
3301 C ST STE 200E
Sacramento, CA 95816
(949) 202-9648
✔ PECOS✔ Accepts Medicare33 mi
Hannah Wong, M.D.
Pathology
NPI 1760654495
3301 C ST STE 200E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare33 mi
Alae Yaseen, M.D.
Pathology
NPI 1902224488
3301 C ST STE 200E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare33 mi
Jonathan Musicant, M.D.
Pathology
NPI 1366412025
6501 COYLE AVE
Carmichael, CA 95608
(916) 537-5275
✔ PECOS✔ Accepts Medicare38 mi
Dario Caccamo, M.D.
Pathology
NPI 1861412355
3301 C ST SUITE #200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare57 mi
Mary Keohane, M.D.
Pathology
NPI 1003922329
3301 C ST SUITE 200E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare57 mi
Derek Marsee, MD, PHD
Pathology
NPI 1952592743
3301 C STREET SUITE 200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare57 mi
Norman Mcmurry, M.D.
Pathology
NPI 1215950977
3301 C ST SUITE #200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare57 mi
Kai Ni, M.D.
Pathology
NPI 1588675847
3301 C ST SUITE #200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare57 mi
Ronald Rowberry, M.D.
Pathology
NPI 1922010941
3301 C ST SUITE 200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare57 mi
Kim Wang, M.D.
Pathology
NPI 1174615215
3301 C ST SUITE #200-E
Sacramento, CA 95816
(916) 447-6267
✔ PECOS✔ Accepts Medicare57 mi
Steven Long, M.D.
Pathology
NPI 1194737908
1825 4TH ST RM L2181A
San Francisco, CA 94143
(415) 353-4554
✔ PECOS✔ Accepts Medicare62 mi
Bijayee Shrestha, MBBS, PHD
Pathology
NPI 1629268453
2500 GRANT RD ROOM GC33
Mountain View, CA 94040
(650) 940-7033
✔ PECOS✔ Accepts Medicare68 mi
See all 38 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 05D2101404

Diagnostic Pathology Medical Group Inc · Sacramento, CA
Active · expires Apr 25, 2027
CLIA Number05D2101404
Laboratory TypePhysician Office
Certificate Effective DateApril 26, 2025
Certificate Expiration DateApril 25, 2027
Laboratory DirectorDr. Ly Ma
Laboratory Phone(916) 440-6317
Laboratory LocationDiagnostic Pathology Medical Group Inc2801 K St Ste 235, Sacramento, CA 95816
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Diagnostic Pathology Medical Group Inc's NPI number?

The NPI number for Diagnostic Pathology Medical Group Inc is 1023673167. It was assigned to this organization in the NPPES registry on May 3, 2019.

Where is Diagnostic Pathology Medical Group Inc located?

Diagnostic Pathology Medical Group Inc is located at 975 S Fairmont Ave, Lodi, CA 95240. The listed phone number is (916) 447-6267.

What is Diagnostic Pathology Medical Group Inc's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Is Diagnostic Pathology Medical Group Inc enrolled in Medicare?

Yes. Diagnostic Pathology Medical Group Inc is registered in the Medicare PECOS enrollment system.

When is Diagnostic Pathology Medical Group Inc's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Diagnostic Pathology Medical Group Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 38 clinicians, all in Pathology, reassign their Medicare billing to Diagnostic Pathology Medical Group Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Diagnostic Pathology Medical Group Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 05D2101404) is associated with this NPI, valid through April 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Diagnostic Pathology Medical Group Inc was last updated on May 3, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.