NPIMap

Organization Active NPI

Lake Loveland Dermatology PC

  • Dermatology Physician
  • Loveland, CO
National Provider Identifier
1679646582
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LAKE LOVELAND DERMATOLOGY PC
Practice address
1708 Boise Ave
Loveland, CO 80538-4204
Phone
(970) 667-3116
Fax
(970) 669-0159
NPI assigned
Nov 16, 2006
Last updated
Nov 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Authorized official

Name
Kevin John Mott, MDNPI 1295776201
Title
Owner
Phone
(303) 569-7700

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X CO Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU

Addresses

Primary practice location

1708 Boise Ave
Loveland, CO 80538-4204

Mailing address

PO Box 7643
Loveland, CO 80537-0643
Phone (970) 663-2742

Other practice location 1

6801 W 20th St Unit 202
Greeley, CO 80634-9640
Phone (970) 667-3116

Other identifiers 1

IdentifierTypeStateIssuer
04014833MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040923001237 CO Part B Supplier - Clinic/Group Practice 1456329655 Receives reassigned benefits from 7 practitioners
3 other NPIs on this enrollment
Practice locations: Fort Collins, CO; Loveland, CO; Sterling, CO; Windsor, CO

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

3464 S Willow St
#6868
Denver, CO 80231

1101 Oakridge Dr
Fort Collins, CO 80525
Phone (970) 207-9773

6801 W 20th St
Unit 202
Greeley, CO 80634
Phone (970) 330-5391

776 W Eisenhower Blvd
Loveland, CO 80537
Phone 3034426647309

Practitioners & affiliated clinicians

Practitioners 8

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1679646582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7643",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370643",
            "telephone_number": "970-663-2742",
            "fax_number": "970-342-2093"
        },
        {
            "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": "970-667-3116",
            "fax_number": "970-669-0159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6801 W 20th St Unit 202",
            "address_purpose": "LOCATION",
            "city": "Greeley",
            "state": "CO",
            "postal_code": "806349640",
            "country_code": "US",
            "telephone_number": "970-667-3116",
            "fax_number": "970-669-0159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE LOVELAND DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "MOTT",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-569-7700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04014833",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loveland, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; 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.