NPIMap

Organization Active NPI

Pathology Associates of Mason City

  • Anatomic Pathology & Clinical Pathology Physician
  • Mason City, IA
National Provider Identifier
1073550810
Registry record updated Apr 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
NOT APPLICABLE Issued in IA
Legal business name
PATHOLOGY ASSOCIATES OF MASON CITY
Practice address
1000 4TH St SW
Mason City, IA 50401-2800
Phone
(641) 424-7488
Fax
(641) 424-7988
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2014

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

Authorized official

Name
Steven Peter Goetz, M.D.
Title
Chief Pathologist
Phone
(641) 428-7487

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X NOT APPLICABLE IA Primary

Addresses

Primary practice location

1000 4TH St SW
Mason City, IA 50401-2800

Mailing address

1408 6TH St SW
Mason City, IA 50401-4818
Phone (641) 424-0102

Other identifiers 2

IdentifierTypeStateIssuer
0317842MedicaidIA
31784OtherIAWELLMARK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323001894 IA Part B Supplier - Clinic/Group Practice 0648161067 Receives reassigned benefits from 6 practitioners
Practice locations: Mason City, IA

National Provider Directory

National Provider Directory

Locations

1408 6th St SW
Mason City, IA 50401
Phone (641) 423-3903

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397779200000",
    "number": "1073550810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 6TH ST SW",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504014818",
            "telephone_number": "641-424-0102",
            "fax_number": "641-424-6709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 4TH ST SW",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504012800",
            "telephone_number": "641-424-7488",
            "fax_number": "641-424-7988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY ASSOCIATES OF MASON CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2014-04-18",
        "status": "A",
        "authorized_official_last_name": "GOETZ",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "CHIEF PATHOLOGIST",
        "authorized_official_telephone_number": "641-428-7487",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IA",
            "license": "NOT APPLICABLE",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0317842",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "31784",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2014; 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.