NPIMap

Organization Active NPI

Mattison Pathology, L.L.P.

  • Anatomic Pathology & Clinical Pathology Physician
  • Edmond, OK
National Provider Identifier
1912685686
Registry record updated Jul 11, 2023
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.
Practice address
1800 Renaissance Blvd Ste L100
Edmond, OK 73013-3023
Phone
(877) 232-9924
NPI assigned
Jul 11, 2023
Last updated
Jul 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Authorized official

Name
Andrew Wyne
Title
Cfo
Phone
(877) 232-9924

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

1800 Renaissance Blvd Ste L100
Edmond, OK 73013-3023

Mailing address

6221 Riverside Dr Ste 119
Irving, TX 75039-3515

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230927000240 OK Part B Supplier - Clinic/Group Practice 6204721467 Receives reassigned benefits from 6 practitioners
Practice locations: Edmond, OK

Other NPIs with the same Medicare PAC ID 1

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

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.

Locations

5230 S State Rd
Ste 1A
Ann Arbor, MI 48108
Phone (855) 293-2936

6060 N Central Expy
Ste 262
Dallas, TX 75206
Phone (214) 986-6251

6221 Riverside Dr
Ste 119
Irving, TX 75039
Phone (469) 232-9920

Practitioners & affiliated clinicians

Practitioners 11

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": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1912685686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 RIVERSIDE DR STE 119",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750393515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 RENAISSANCE BLVD STE L100",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133023",
            "telephone_number": "877-232-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTISON PATHOLOGY, L.L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "WYNE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "877-232-9924"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; 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.