Individual provider Active NPI

Matthew James Connolly, D.P.M.

  • Podiatrist
  • Edgewood, KY
National Provider Identifier
1023010279
Registry record updated Jul 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
244122 Issued in KY
Practice address
560 S Loop Rd
Edgewood, KY 41017-3405
Phone
(859) 301-2663
Fax
(859) 817-7848
NPI assigned
Jun 1, 2005
Last updated
Jul 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2021

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 244122 KY Primary
Primary Podiatric Medicine Podiatrist 213EP1101X 244122 KY
Primary Podiatric Medicine Podiatrist 213EP1101X 00180 KY
Foot & Ankle Surgery Podiatrist 213ES0103X 00180 KY
Foot & Ankle Surgery Podiatrist 213ES0103X 244122 KY

Addresses

Primary practice location

560 S Loop Rd
Edgewood, KY 41017-3405

Mailing address

560 S Loop Rd
Edgewood, KY 41017-3405
Phone (859) 301-2663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091205000077 KY Practitioner - Podiatry 1759294168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Kent State University College of Podiatric Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

560 S Loop Rd
Edgewood, KY 41017-3405
Phone (859) 301-2663

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue237
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
244122KYMDPodiatrist
00180KYMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthocincy Orthopaedics & Sports Medicine PSC CurrentSince Jan 1, 2003 Accepting new patients
Orthocincy Orthopaedics & Sports Medicine PSC Podiatrist CurrentSince Jan 1, 2003 Accepting new patients

Locations

560 S Loop Rd
Edgewood, KY 41017
Phone (859) 817-3599

500 Thomas More Pkwy
Ft Mitchell, KY 41017
Phone (859) 341-4525

2626 Alexandria Pike
Ste 100
Highland Heights, KY 41076
Phone (859) 817-3599

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

Dept L700
Cincinnati, OH 45270

Interoperability endpoints

  • Direct secure messaging: mconnolly@coc1897.srs-direct.com
  • Direct secure messaging: mconnolly27071@direct-prd.stelizabeth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1023010279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173405",
            "telephone_number": "859-301-2663",
            "fax_number": "859-301-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173405",
            "telephone_number": "859-301-2663",
            "fax_number": "859-817-7848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "KY",
            "license": "244122",
            "primary": true
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "KY",
            "license": "244122",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "KY",
            "license": "00180",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KY",
            "license": "00180",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KY",
            "license": "244122",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.