Great Lakes Pathologists SC
NPI 1689695934ActiveOrganization· Pathology, Anatomic Pathology & Clinical Pathology· West Allis, WI
Pathology, Anatomic Pathology & Clinical Pathology in West Allis, Wisconsin, registered in NPPES in July 2006. The authorized official on file is Jimmy R. Clark, M.D., President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1689695934 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 22, 2006 |
| Last updated in NPPES | Oct 17, 2026 |
| Certified by provider | Oct 17, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pathology, Anatomic Pathology & Clinical Pathology Primary | 207ZP0102X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WI) |
|---|
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