DMMD Concierge LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DMMD CONCIERGE LLC

Practice address

947 Eastern Pkwy
Louisville, KY 40217-1573

Phone

(502) 361-8801

Fax

(502) 361-8821

NPI assigned

Nov 14, 2019

Organization subpart

No

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

Authorized official

Name

Doug Mattingly, MD

Title

Owner

Phone

(502) 361-8801

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Douglas E Mattingly, M.D.

  • Family Medicine Physician
  • Louisville, KY
  • NPI 1801851886
  Medicare reassignment Care Compare group NPD
• Thaddeus Beam Riley, PA

  • Medical Physician Assistant
  • Louisville, KY
  • NPI 1144417999
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1573689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1114562014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3202 THOUSAND OAKS DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "947 EASTERN PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171573",
            "telephone_number": "502-361-8801",
            "fax_number": "502-361-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DMMD CONCIERGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-14",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "MATTINGLY",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-361-8801",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100646490",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• DK Gopinath MD PSC
• DLS Medical Associates, LLC
• DME
• Dmhdmd Inc
• Sergei Veniaminovich Dmitruk, MD
• DO Medical Consulting
• DO Not Use
• DO Not Use
• DO Not Use
• Khoi K DO

• Family Medicine Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.