CMS-1500 Box 24J / 33a • NPI
1154675742
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
291U00000X (CMS 69)
CLIA-Certified Diagnostic Medical & Pathology Laboratory
Box 32 Service Location & ZIP+4
5201 GREAT AMERICA PKWY, SUITE 320, SANTA CLARA, CA, 95054-1122
✓ 9-Digit EDI 837 ZIP+4 (95054-1122)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1154675742 (AGATHOS LABORATORIES, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1154675742 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | AGATHOS LABORATORIES, INC. |
| Plain-English Specialty | CLIA-Certified Diagnostic Medical & Pathology Laboratory NUCC Code: 291U00000X (Clinical Medical Laboratory) |
| Certifying / Licensing Body | CMS CLIA / College of American Pathologists (CAP) |
| Practice Location Address | 5201 GREAT AMERICA PKWY, SUITE 320, SANTA CLARA, CA, 95054-1122 |
| Practice Telephone / Fax | Tel: (408) 730-6819 | Fax: (408) 562-5745 |
| Administrative Mailing Address | 5201 GREAT AMERICA PKWY, SANTA CLARA, CA, 95054-1122 |
| Enumeration & Last Sync | Enumerated: 2012-11-04 | CMS Record Updated: 2014-01-21 |
| Authorized Official | PAUL MOMOH (President) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (291U00000X)
What Does Taxonomy Code 291U00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 291U00000X translates to:
"CLIA-Certified Diagnostic Medical & Pathology Laboratory"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (AGATHOS LABORATORIES, INC.)
Typical CPT / Diagnostic Procedures:- Complete Blood Count (CBC) with Automated Differential (CPT 85025)
- Comprehensive Metabolic Panel (CMP), Fractionated Bilirubin & Hepatic Panel
- Quantitative Urine Culture & Colony Count (≥ 10⁵ CFU/mL) with Antibiotic Susceptibility
- HbA1c, Lipid Panel, TSH & High-Sensitivity Troponin Assays
- Diagnostic Reagent Panels & CLSI Antimicrobial Susceptibility Disks/MIC Cards
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
332B00000X — Durable Medical Equipment & Medical SuppliesPlain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies | State: CA | License: GH102230817 | Primary: Secondary |
305S00000X — Point of ServicePlain English: Licensed & Credentialed Point of Service | State: CA | License: GH102230817 | Primary: Secondary |
291900000X — Military Clinical Medical LaboratoryPlain English: CLIA-Certified Diagnostic Medical & Pathology Laboratory | State: CA | License: GH102230817 | Primary: Secondary |
291U00000X — Clinical Medical LaboratoryPlain English: CLIA-Certified Diagnostic Medical & Pathology Laboratory | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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