{"npi":"1861568784","type":"NPI-2","status":"active","name":{"display":"Ambry Genetics Corporation","other":[],"organization_name":"AMBRY GENETICS CORPORATION","authorised_official":"Michael Martinson"},"specialty":{"primary_taxonomy":"291U00000X","primary_taxonomy_description":"Clinical Medical Laboratory","slug":"clinical-medical-laboratory","schema_org_specialty":"Pathology","all":[{"code":"291U00000X","description":"Clinical Medical Laboratory","primary":false,"state":"CA","license":"CLF11694"},{"code":"291U00000X","description":"Clinical Medical Laboratory","primary":true,"state":"CA","license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"7 ARGONAUT","city":"ALISO VIEJO","state":"CA","postal_code":"926561423","country_code":"US","phone":"9499005500","fax":"9499005501"},{"purpose":"MAILING","street_1":"1 ENTERPRISE","city":"ALISO VIEJO","state":"CA","postal_code":"926562606","country_code":"US","phone":"9494574143","fax":"9499005501"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"0421379","state":"MT","issuer":null},{"type_code":"05","label":"Medicaid","value":"1024063580001","state":"PA","issuer":null},{"type_code":"05","label":"Medicaid","value":"1061577","state":"WA","issuer":null},{"type_code":"05","label":"Medicaid","value":"419149800","state":"MD","issuer":null},{"type_code":"05","label":"Medicaid","value":"462462900","state":"MN","issuer":null},{"type_code":"05","label":"Medicaid","value":"7100029600","state":"KY","issuer":null},{"type_code":"05","label":"Medicaid","value":"L00282","state":"SC","issuer":null},{"type_code":"05","label":"Medicaid","value":"1517245","state":"TN","issuer":null},{"type_code":"05","label":"Medicaid","value":"15197","state":"ND","issuer":null},{"type_code":"05","label":"Medicaid","value":"200034590A","state":"OK","issuer":null},{"type_code":"05","label":"Medicaid","value":"453277016","state":"MI","issuer":null},{"type_code":"01","label":"Other","value":"7154701","state":"CA","issuer":"LAP CAP"},{"type_code":"05","label":"Medicaid","value":"806650800","state":"ID","issuer":null},{"type_code":"05","label":"Medicaid","value":"0054976","state":"NJ","issuer":null},{"type_code":"05","label":"Medicaid","value":"010127904","state":"VA","issuer":null},{"type_code":"05","label":"Medicaid","value":"10025004600","state":"NE","issuer":null},{"type_code":"05","label":"Medicaid","value":"1006834","state":"AK","issuer":null},{"type_code":"05","label":"Medicaid","value":"200967250A","state":"IN","issuer":null},{"type_code":"05","label":"Medicaid","value":"212446302","state":"TX","issuer":null},{"type_code":"05","label":"Medicaid","value":"69584834","state":"CO","issuer":null},{"type_code":"05","label":"Medicaid","value":"797178","state":"AZ","issuer":null},{"type_code":"05","label":"Medicaid","value":"157113709","state":"AR","issuer":null},{"type_code":"05","label":"Medicaid","value":"003151337A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"1017246","state":"VT","issuer":null},{"type_code":"05","label":"Medicaid","value":"2958381","state":"NY","issuer":null},{"type_code":"05","label":"Medicaid","value":"86759825","state":"NM","issuer":null},{"type_code":"05","label":"Medicaid","value":"9880101-000","state":"WV","issuer":null},{"type_code":"05","label":"Medicaid","value":"1464660","state":"LA","issuer":null},{"type_code":"05","label":"Medicaid","value":"212446301","state":"TX","issuer":null},{"type_code":"05","label":"Medicaid","value":"690000008","state":"AL","issuer":null},{"type_code":"05","label":"Medicaid","value":"LAB81414F","state":"CA","issuer":null},{"type_code":"05","label":"Medicaid","value":"200267720A","state":"KS","issuer":null},{"type_code":"05","label":"Medicaid","value":"2418146","state":"OH","issuer":null},{"type_code":"05","label":"Medicaid","value":"775960","state":"MS","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20031217001138","type_code":"12-69","type_desc":"PART B SUPPLIER - INDEPENDENT CLINICAL LABORATORY","state":"CA","pac_id":"7416854385"}]},"enumeration_date":"2006-11-24","last_updated":"2024-08-22","_meta":{"source":"NPPES","snapshot_date":"2024-08-22","doc_url":"https://findmynpi.com/api"}}