Ingerlisa Mattoch MD Inc

Primary specialty

Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X

Legal business name

INGERLISA MATTOCH MD INC

Doing business as

Tiaga Pathology

Practice address

1708 Boise Ave
Loveland, CO 80538-4204

Phone

(708) 186-7889

NPI assigned

May 25, 2022

Last updated

Jun 14, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ingerlisa Mattoch, MDNPI 1306034582

Title

Authorized Representative

Phone

(970) 818-6788

Specialties & licenses 3

Addresses

Other names 1

• Tiaga Pathology Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Practitioners 7

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.

• Ingerlisa Wenche Mattoch, M.D.

  • Dermatopathology (Pathology) Physician
  • Loveland, CO
  • NPI 1306034582
  Medicare reassignment NPD Authorized official
• Nichole Louise Hart, C.R.N.P

  • Family Nurse Practitioner
  • Loveland, CO
  • NPI 1295076297
  NPD
• Kevin John Mott, MD

  • MOHS-Micrographic Surgery Physician
  • Loveland, CO
  • NPI 1295776201
  NPD
• Kathryn L Olsen, PA

  • Physician Assistant
  • Loveland, CO
  • NPI 1902889124
  NPD
• David Joseph Seitz IV, P.A.-C.

  • Medical Physician Assistant
  • Loveland, CO
  • NPI 1235169194
  NPD
• Michaela Paige Sullivan, PA-C

  • Physician Assistant
  • Loveland, CO
  • NPI 1982308193
  NPD
• Meredith S Williams, C-PA

  • Medical Physician Assistant
  • Loveland, CO
  • NPI 1194717900
  NPD

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1467190736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7268",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370268",
            "telephone_number": "970-663-2742",
            "fax_number": "970-667-0847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 BOISE AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805384204",
            "telephone_number": "708-186-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGERLISA MATTOCH MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "MATTOCH",
        "authorized_official_first_name": "INGERLISA",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "970-818-6788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tiaga Pathology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatopathology (Pathology) Physician in Loveland, CO
• Providers in Loveland, CO by specialty
• Dermatopathology (Pathology) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; 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.