MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC.
NPI 1063477461
Pathology - Anatomic Pathology & Clinical Pathology in Wildomar, CA
About Medical Laboratory Services Medical Group, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MEDICAL LABORATORY SERVICES MEDICAL GROUP, INC. (NPI 1063477461) is a healthcare organization registered as an anatomic pathology & clinical pathology in Wildomar, California and active in the NPI registry since April 2006. The organization lists Ernest N Holburt, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Medical Laboratory Services Medical Group, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Medical Laboratory Services Medical Group, Inc., which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Medical Laboratory Services Medical Group, Inc.'s NPI number?
The NPI number for Medical Laboratory Services Medical Group, Inc. is 1063477461. It was assigned to this organization in the NPPES registry on April 19, 2006.
Where is Medical Laboratory Services Medical Group, Inc. located?
Medical Laboratory Services Medical Group, Inc. is located at 36485 Inland Valley Dr, Wildomar, CA 92595. The listed phone number is (760) 731-3334.
What is Medical Laboratory Services 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 Medical Laboratory Services Medical Group, Inc. enrolled in Medicare?
Yes. Medical Laboratory Services Medical Group, Inc. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Medical Laboratory Services Medical Group, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Pathology, reassign their Medicare billing to Medical Laboratory Services 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, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Medical Laboratory Services Medical Group, Inc. was last updated on August 20, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.
# Medical Laboratory Services Medical Group, Inc. · NPI 1063477461
Anatomic Pathology & Clinical Pathology organization in Wildomar, California. Organization record, active in the CMS NPPES registry since April 19, 2006.
## Identity
- **NPI:** 1063477461 (Entity type: Organization)
- **Enumerated:** April 19, 2006
- **Primary specialty:** Pathology - Anatomic Pathology & Clinical Pathology · taxonomy 207ZP0102X
- **Organization subpart:** No
- **Authorized official:** Ernest Holburt, PRESIDENT
## Practice location
- **Address:** 36485 INLAND VALLEY DR, Wildomar, CA 92595-9681
- **Phone:** (760) 731-3334
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians (Pathology) reassign Medicare billing to this organization (form CMS-855R); 3 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 20, 2009
- **Other identifiers:** Medicaid GR0092911 (CA); Medicare PIN ZZZ07698Z (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1063477461) · Data from the CMS NPPES public registry.