NPIMap

Individual provider Active NPI

Jameson Kyle Mattingly, M.D.

  • Otology & Neurotology Physician
  • Knoxville, TN
National Provider Identifier
1255697975
Registry record updated Dec 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
62735 Issued in TN
Practice address
9430 Park West Blvd Ste 330
Knoxville, TN 37923-4203
Phone
(865) 693-6065
Fax
(865) 531-6325
NPI assigned
Apr 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X 62735 TN
Otology & Neurotology Physician 207YX0901X 62735 TN Primary

Addresses

Primary practice location

9430 Park West Blvd Ste 330
Knoxville, TN 37923-4203

Mailing address

9430 Park West Blvd Ste 330
Knoxville, TN 37923-4203
Phone (865) 693-6065

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210205001683 TN Practitioner - Otolaryngology 3577704568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Louisville School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tennessee Ear, Nose and Throat Consultants, PCGroup PAC ID 5092763532, 25 clinicians

Practice addresses (Care Compare)

9430 Park W Blvd
Suite 330
Knoxville, TN 37923-4203
Phone (865) 693-6065

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
62735TNMDOtology & Neurotology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee Ear, Nose & Throat Consultants, PC Plastic Surgery Within the Head & Neck CurrentSince Mar 1, 2021 Accepting new patients
Otolaryngology Center of East Tennessee PC Past Accepting new patients
Boulevard ENT Surgery Center LLC PastSince May 17, 2023 Accepting new patients

Locations

9430 Park West Blvd
Ste 330
Knoxville, TN 37923
Phone (865) 271-6534

Dept 888604
Knoxville, TN 37995

576 Fort Loudoun Med Center Dr
Ste 207
Lenoir City, TN 37772
Phone (865) 271-6534

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702080000000",
    "number": "1255697975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9430 PARK WEST BLVD STE 330",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234203",
            "telephone_number": "865-693-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 PARK WEST BLVD STE 330",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234203",
            "telephone_number": "865-693-6065",
            "fax_number": "865-531-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "JAMESON",
        "middle_name": "KYLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-06",
        "last_updated": "2023-12-09",
        "certification_date": "2023-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "TN",
            "license": "62735",
            "primary": false
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "TN",
            "license": "62735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.