Lisa A Mattingly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME146476 Issued in FL

Practice address

1050 Loveland Blvd
Port Charlotte, FL 33980-1813

Phone

(941) 764-0301

NPI assigned

May 25, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles (2 of 4)

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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

• Florida Medical Associates LLC

  • Primary Care Clinic/Center
  • Lady Lake, FL
  • NPI 1336153709
  Medicare reassignment NPD
• Medical Risk Solutions

  • Family Medicine Physician
  • Port Charlotte, FL
  • NPI 1972078160
  NPD (past)

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

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777593600000",
    "number": "1104186907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2710 REW CIR STE 200",
            "city": "OCOEE",
            "state": "FL",
            "postal_code": "347612967",
            "telephone_number": "888-373-0013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 LOVELAND BLVD",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339801813",
            "telephone_number": "941-764-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "LISA",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-25",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME146476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200444630A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "430265YRHZ",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michaela Grace Mathis-Hagarty
• Deborah M Mathis, LCSW
• Evisencia G Mathurin, DNP
• Matthew Bagan DO PA
• Thomas Matthews
• Sarai Matzicoff Pena
• Mason S. Maulsby, ARNP
• Arlen Maunahan
• Margaret G Mayo, MD
• Walter Mazeiko Jr., HAS

• Family Medicine Physician in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; 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.