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LAKE LOVELAND DERMATOLOGY PC
NPI 1073114948
Dermatology in Windsor, CO

Active since November 05, 2020CLIA 06D0516376 · Certificate of Compliance
1683 MAIN ST, WINDSOR, CO 80550(970) 667-3116(970) 669-0159 Get Directions Write a Review

NPPES record last updated: January 19, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 19, 2021, Nov 5, 2020 (2 updates tracked since 2020).

About Lake Loveland Dermatology Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE LOVELAND DERMATOLOGY PC (NPI 1073114948) is a healthcare organization registered as a dermatology in Windsor, Colorado and active in the NPI registry since November 2020. The organization holds a CLIA Certificate of Compliance certificate valid through June 6, 2028 and lists Kevin John Mott, Owner, as its authorized official.

NPPES Registry Identity

NPI1073114948
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameLAKE LOVELAND DERMATOLOGY PC
Location Address1683 MAIN STWindsor, CO 80550-7921
Mailing AddressPo Box 7643Loveland, CO 80537-0643 · (970) 663-2742 · Fax (970) 342-2093
Phone(970) 667-3116
Fax(970) 669-0159
Organization SubpartNo
Authorized OfficialKevin John MottOwner · (303) 569-7700
Enumeration DateNovember 5, 2020
Last NPPES UpdateJanuary 19, 20212 updates tracked since enumeration
NPPES CertifiedJanuary 19, 2021
✔ NPI 1073114948 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
1683 MAIN ST, Windsor, CO 80550
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Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lake Loveland Dermatology Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Lake Loveland Dermatology PC, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Ingerlisa Mattoch, M.D.
Pathology
NPI 1306034582
1708 N. BOISE
Loveland, CO 80538
(970) 818-6788
✔ PECOS7.8 mi
Nichole Hart, C.R.N.P
Nurse Practitioner
NPI 1295076297
1708 BOISE AVE
Loveland, CO 80538
(970) 667-3116
✔ PECOS✔ Accepts Medicare7.9 mi
Kevin Mott, MD
Dermatology
NPI 1295776201
1708 BOISE AVE
Loveland, CO 80538
(970) 667-3116
✔ PECOS✔ Accepts Medicare7.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 06D0516376

Lake Loveland Dermatology · Loveland, CO
Active · expires Jun 6, 2028
CLIA Number06D0516376
Laboratory TypePhysician Office
Certificate Effective DateJune 7, 2026
Certificate Expiration DateJune 6, 2028
Laboratory DirectorDr. Ingerlisa W. Mattoch
Laboratory Phone(970) 667-3116
Laboratory LocationLake Loveland Dermatology1708 N Boise Ave, Loveland, CO 80538
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Loveland Dermatology PC's NPI number?

The NPI number for Lake Loveland Dermatology PC is 1073114948. It was assigned to this organization in the NPPES registry on November 5, 2020.

Where is Lake Loveland Dermatology PC located?

Lake Loveland Dermatology PC is located at 1683 Main St, Windsor, CO 80550. The listed phone number is (970) 667-3116.

What is Lake Loveland Dermatology PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Lake Loveland Dermatology PC enrolled in Medicare?

Yes. Lake Loveland Dermatology PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lake Loveland Dermatology PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Lake Loveland Dermatology PC, in Dermatology, Nurse Practitioner and Pathology. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Lake Loveland Dermatology PC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 06D0516376) is associated with this NPI, valid through June 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lake Loveland Dermatology PC was last updated on January 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.