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DR. GREGG R MATTISON M.D. NPI 1023062130


NPI Information

NPI: 1023062130
Provider Name: DR. GREGG R MATTISON, M.D.
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Address:
3707 NEW VISION DRIVE
FORT WAYNE, IN
ZIP 46895
Phone: (260) 471-9466
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DR. Gregg R Mattison, M.D. is a diagnostic radiology radiology in Fort Wayne, IN. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Gregg R Mattison, M.D. NPI is 1023062130. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3707 NEW VISION DRIVE
FORT WAYNE, IN
ZIP 46895-602
Phone: (260) 471-9466
Fax: (260) 484-5919

The enumeration date for this NPI number is 5/22/2006 and was last updated on 7/8/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12085R0202XRadiologyDiagnostic Radiology35188INDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1194930IMEDICARE ID-TYPE UNSPECIFIEDINDIANA
2924750OMEDICARE ID-TYPE UNSPECIFIEDINDIANA
3000000092615OTHERINDIANAANTHEM
4191150IMEDICARE ID-TYPE UNSPECIFIEDINDIANA
5163520KMEDICARE ID-TYPE UNSPECIFIEDINDIANA
6MA4111451MEDICARE ID-TYPE UNSPECIFIEDOHIO
7147380NMEDICARE ID-TYPE UNSPECIFIEDINDIANA
8055740HMEDICARE ID-TYPE UNSPECIFIEDINDIANA
91554OTHERINDIANAPHP
10B44955MEDICARE UPININDIANA
11190320LMEDICARE ID-TYPE UNSPECIFIEDINDIANA
12925240HMEDICARE ID-TYPE UNSPECIFIEDINDIANA
132100630MEDICAIDOHIO
144074924100MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.