DR. GREGG R MATTISON (NPI# 1023062130) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023062130 |
| Entity Type | Individual |
| Full Name | DR. GREGG R MATTISON |
| Credential | M.D. |
| Practice Address |
3707 New Vision Drive Fort Wayne IN 46895-5602 |
| Mailing Address |
2200 Randallia Dr Fort Wayne IN 46805-4638 |
| Practice Telephone | 2604719466 |
| Practice Fax Number | 2604845919 |
| Mailing Telephone | 2603734731 |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
35188 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2100630 | 05 | |
| IN | ANTHEM | 000000092615 | 01 |
| IN | PHP | 1554 | 01 |
| MI | 4074924100 | 05 |
| Street Address |
3707 NEW VISION DRIVE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46895-5602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992711576 | George H Kinnebrew | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46895-5602 | 2006-08-01 |
| 1114971223 | Brad M Johnston | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46895-5602 | 2006-05-22 |
| 1932153046 | Kevin F O'connor V | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46895-5602 | 2006-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366043002 | Lauren Neuenschwander | Dietitian, Registered | 10017 Schuyler Ct, Fort Wayne, IN 46804-4377 | 2020-11-07 |
| 1629679170 | Gentlemind Health Services | Clinic/Center | 3635 Lake Ave, Fort Wayne, IN 46805-5539 | 2020-11-02 |
| 1710587548 | Laura Raquel Rochford | Social Worker | 3702 New Vision Dr Bldg B, Fort Wayne, IN 46845-1703 | 2020-10-30 |
| 1518566397 | Stacey Renee Pulver | Nurse Practitioner | 13134 Hollow Oak Rd, Fort Wayne, IN 46845-2327 | 2020-10-22 |
| 1891394599 | Laury Farrell | Nurse Practitioner | 6017 Stoney Creek Dr, Fort Wayne, IN 46825-4410 | 2020-10-22 |
| 1629677604 | Dameta Diane Williams | Massage Therapist | 3525 Lake Ave, Fort Wayne, IN 46805-5599 | 2020-10-21 |
| 1730787599 | Crystal Neal | Nurse Practitioner | 4430 Keeneland Ln Unit 202, Fort Wayne, IN 46845-1985 | 2020-10-14 |
| 1649878554 | Heather Ormiston-leclear | Nurse Practitioner | 3800 N Anthony Blvd # Cc1335, Fort Wayne, IN 46805-1430 | 2020-10-13 |
| 1033717293 | Eva Marie Richardville | Occupational Therapist | 311 Airport North Office Park, Fort Wayne, IN 46825-6703 | 2020-10-10 |
| 1417555640 | Kara Peas | Physical Therapist | 11104 Parkview Circle Dr Ste 50, Fort Wayne, IN 46845-1733 | 2020-10-10 |
| Find all providers in FORT WAYNE | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376789420 | Richard Frederick Fox | Radiology | 6226 Devils Hollow Rd., Fort Wayne, IN 46814 | 2008-12-19 |
| 1578607149 | Garland Richard Brown | Radiology | 1007 Three Rivers N, Fort Wayne, IN 46802-1334 | 2007-02-16 |
| 1932205077 | Kavita K Erickson | Radiology | 5001 Us Highway 30 W, Suite D, Fort Wayne, IN 46818-9701 | 2006-09-16 |
| 1033226154 | Alan S. Cooperman | Radiology | 14110 Spring Hollow Rd, Fort Wayne, IN 46814-9767 | 2006-08-24 |
| 1336174598 | Mitchell E F Travis | Radiology | 10517 Maple Springs Cv, Fort Wayne, IN 46845-2132 | 2006-07-12 |
| 1184678278 | Charles Tsai | Radiology | 109 Chestnut Hills Pkwy, Fort Wayne, IN 46814-8924 | 2006-05-22 |
| 1922061613 | Mri Center - Fort Wayne Radiology Inc | Radiology | 2110 Carew St, Fort Wayne, IN 46805-4712 | 2006-04-11 |
| 1861455669 | Open View Mri, LLC | Radiology | 10202 Coldwater Rd, Fort Wayne, IN 46825-2076 | 2006-04-11 |
| 1902870033 | Jay T Jones | Radiology | 3707 New Vision Dr, Fort Wayne, IN 46845-1702 | 2006-02-15 |
| 1871564336 | Imaging Diagnostic Center Limited | Radiology | 7900 W Jefferson Blvd Ste 101, Fort Wayne, IN 46804-4128 | 2006-01-31 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46895 |
Please comment or provide details below to improve the information on DR. GREGG R MATTISON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.