NPIMap

Organization Active NPI

Mattison Pathology, L.L.P.

Doing business as Avero Diagnostics

  • Anatomic Pathology & Clinical Pathology Physician
  • Dallas, TX
National Provider Identifier
1063619922
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
MATTISON PATHOLOGY, L.L.P.
Doing business as
Avero Diagnostics
Practice address
4245 N Central Expy Ste 420
Dallas, TX 75205-4566
Phone
(866) 987-7284
Fax
(469) 232-9927
NPI assigned
Jul 2, 2007
Last updated
Dec 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gregory M Wolgamot, M.D., PH.D.NPI 1801849369
Title
Medical Director
Phone
(866) 987-7284

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU
Cytopathology Physician 207ZC0500X NU
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary

Addresses

Primary practice location

4245 N Central Expy Ste 420
Dallas, TX 75205-4566

Mailing address

3560 Meridian St Ste 101
Bellingham, WA 98225-1731
Phone (360) 734-2800

Other practice location 1

4642 N Loop 289 Ste 205
Lubbock, TX 79416-2424
Phone (866) 987-7284

Other identifiers 6

IdentifierTypeStateIssuer
00Z224OtherMEDICARE PTAN
45D1065927OtherTXCLIA
7201511OtherTXCOLLEGE OF AMERICAN PATHOLOGISTS
45D1069527OtherTXCLIA #
45D1015603OtherTXCLIA
7187034OtherTXCOLLEGE OF AMERICAN PATHOLOGISTS

Other names 1

  • Avero Diagnostics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040319001206 TX Part B Supplier - Clinic/Group Practice 6204721467 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Dallas, TX; Lubbock, TX
O20080204000374 TX Part B Supplier - Independent Clinical Laboratory 6204721467 1 other NPI on this enrollment
Practice locations: Dallas, TX; Lubbock, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mattison Pathology LLP3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765756800000",
    "number": "1063619922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3560 MERIDIAN ST STE 101",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251731",
            "telephone_number": "360-734-2800",
            "fax_number": "360-734-0426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4245 N CENTRAL EXPY STE 420",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752054566",
            "telephone_number": "866-987-7284",
            "fax_number": "469-232-9927"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4642 N Loop 289 Ste 205",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794162424",
            "country_code": "US",
            "telephone_number": "866-987-7284",
            "fax_number": "469-232-9927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MATTISON PATHOLOGY, L.L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A",
        "authorized_official_last_name": "WOLGAMOT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "866-987-7284",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "00Z224",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D1065927",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLLEGE OF AMERICAN PATHOLOGISTS",
            "identifier": "7201511",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "45D1069527",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D1015603",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLLEGE OF AMERICAN PATHOLOGISTS",
            "identifier": "7187034",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avero Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.