1. Home
  2. Directory
  3. Nevada
  4. Carson City
  5. Pathology
  6. NPI Profile

DIAGNOSTIC PATHOLOGY MEDICAL GROUP, INC.
NPI 1417636093
Pathology - Anatomic Pathology & Clinical Pathology in Carson City, NV

Active since July 12, 2023CLIA 29D0680086 · Certificate of Compliance
1600 MEDICAL PKWY, CARSON CITY, NV 89703(916) 447-6267(916) 456-5872 Get Directions Write a Review

NPPES record last updated: July 12, 2023. Verified against the NPPES registry weekly; last sync: October 18, 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 1417636093) is a healthcare organization registered as an anatomic pathology & clinical pathology in Carson City, Nevada and active in the NPI registry since July 2023. The organization holds a CLIA Certificate of Compliance certificate valid through April 8, 2027 and lists Jeanette J Boado, Billing Supervisor, as its authorized official.

NPPES Registry Identity

NPI1417636093
Entity TypeOrganization
Primary Taxonomy207ZP0102X
Legal Business NameDIAGNOSTIC PATHOLOGY MEDICAL GROUP, INC.
Location Address1600 MEDICAL PKWYCarson City, NV 89703-4625
Mailing Address3301 C St Ste 200eSacramento, CA 95816-3363 · (916) 447-6267
Phone(916) 447-6267
Fax(916) 456-5872
Organization SubpartNo
Authorized OfficialJeanette J BoadoBilling Supervisor · (916) 447-6267
Enumeration DateJuly 12, 2023
NPPES CertifiedJuly 12, 2023
✔ NPI 1417636093 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.
1600 MEDICAL PKWY, Carson City, NV 89703
Open in Google Maps ↗

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 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).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Diagnostic Pathology Medical Group, Inc., which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (6)

Susan Doberneck, M.D.
Pathology
NPI 1639249022
1600 MEDICAL PKWY
Carson City, NV 89703
(775) 445-8502
✔ PECOS✔ Accepts MedicareSame address
Mark Wolz, MD
Pathology
NPI 1609946094
1600 MEDICAL PKWY
Carson City, NV 89703
(775) 885-4327
✔ PECOS✔ Accepts MedicareSame address
Grant Hayashi, M.D.
Pathology
NPI 1962405290
1350 STARDUST ST STE D
Reno, NV 89503
(775) 746-3400
✔ PECOS✔ Accepts Medicare23 mi
Jonathan Musicant, M.D.
Pathology
NPI 1366412025
6501 COYLE AVE
Carmichael, CA 95608
(916) 537-5275
✔ PECOS✔ Accepts Medicare90 mi
Sasan Setoodeh
Pathology
NPI 1710373147
3301 C ST STE 200E
Sacramento, CA 95816
(949) 202-9648
✔ PECOS✔ Accepts Medicare101 mi
Michael Astudillo, MD
Pathology
NPI 1922538172
MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
Boston, MA 02114
(617) 726-1448
✔ PECOS✔ Accepts Medicare2,529 mi

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 Compliance 29D0680086

Diagnostic Pathology Medical Group, Inc · Carson City, NV
Active · expires Apr 8, 2027
CLIA Number29D0680086
Laboratory TypeIndependent
Certificate Effective DateApril 9, 2025
Certificate Expiration DateApril 8, 2027
Laboratory DirectorMark R Wolz
Laboratory Phone(916) 440-6317
Laboratory LocationDiagnostic Pathology Medical Group, Inc1600 Medical Pkwy, Carson City, NV 89703
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 1417636093. It was assigned to this organization in the NPPES registry on July 12, 2023.

Where is Diagnostic Pathology Medical Group, Inc. located?

Diagnostic Pathology Medical Group, Inc. is located at 1600 Medical Pkwy, Carson City, NV 89703. 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.

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

According to the CMS Revalidation Reassignment List (October 2026 release), 6 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, 2 practice at this address. 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 Compliance (number 29D0680086) is associated with this NPI, valid through April 8, 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 July 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.