NPIMap

Organization Active NPI

Abode Care Partners Al VB, LLC

  • Nurse Practitioner
  • Mason, OH
National Provider Identifier
1104695550
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ABODE CARE PARTNERS AL VB, LLC
Practice address
5467 Cedar Village Dr
Mason, OH 45040-8693
Phone
(800) 807-6555
Fax
(855) 316-2999
NPI assigned
Dec 27, 2023
Last updated
Jun 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

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

Authorized official

Name
Angie Mattingly
Title
MGR Provider Enrollment
Phone
(502) 394-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

5467 Cedar Village Dr
Mason, OH 45040-8693

Mailing address

805 N Whittington Pkwy
Louisville, KY 40222-7101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240123003907 OH Part B Supplier - Clinic/Group Practice 1658403704 Receives reassigned benefits from 53 practitioners
Practice locations: Mason, OH

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Abode Care Partners Al VB LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1703635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780272000000",
    "number": "1104695550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N WHITTINGTON PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402227101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5467 CEDAR VILLAGE DR",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450408693",
            "telephone_number": "800-807-6555",
            "fax_number": "855-316-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABODE CARE PARTNERS AL VB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-27",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A",
        "authorized_official_last_name": "MATTINGLY",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "MGR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "502-394-2100"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason, OH

Sources for this page

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