Theresa Katherine Mattingly, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

125064953 Issued in IL

Practice address

3265 NE Ralph Powell Rd
Lees Summit, MO 64064-2301

Phone

(816) 524-4747

Fax

(816) 524-4929

NPI assigned

Jul 14, 2014

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

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Saint Louis University School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of Southeast Missouri PCGroup PAC ID 3678612108, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110
• Mercy Hospital Perry Hospital, Perryville, MO, CCN 261311
• Saint Francis Medical Center Hospital, Cape Girardeau, MO, CCN 260183

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Cost

100

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tmatt@moon.emadirect.md

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.

• Advanced Dermatology of Southeast Missouri PC

  • Dermatology Physician
  • Cape Girardeau, MO
  • NPI 1770713950
  Medicare reassignment Care Compare group NPD
• Dermatology and Skin Cancer Specialists, LLC.

  • Dermatology Physician
  • Lees Summit, MO
  • NPI 1366632697
  Medicare reassignment NPD
• Skin & Mohs Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Lees Summit, MO
  • NPI 1881875227
  NPD
• Dermatology and Skin Cancer Specialists, LLC

  • Dermatology Physician
  • Leawood, KS
  • NPI 1205880846
  NPD

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

• Mercy Hospital Perry

  • Critical Access Hospital
  • Perryville, MO
  • NPI 1063117158
  Care Compare affiliation
• Saint Francis Medical Center

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1467412726
  Care Compare affiliation
• Saint Francis Medical Center

  • Internal Medicine Physician
  • Cape Girardeau, MO
  • NPI 1578513016

  Hospital

  Care Compare affiliation
• Southeast Hospital

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661
  Care Compare affiliation

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

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1265849053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3265 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642301",
            "telephone_number": "816-524-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3265 NE RALPH POWELL RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640642301",
            "telephone_number": "816-524-4747",
            "fax_number": "816-524-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "THERESA",
        "middle_name": "KATHERINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-14",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "125064953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tori Mathews, PA-C
• Paul Thomas Matlock, D.D.S.
• Bryn Mattes
• Kathi Jo Matthes, D.D.S.
• Jaiden Taylor Mattic, RBT
• Christopher M Mattix, PLPC
• Jennifer Lynn Mattson, MPT
• Christopher J Maugans, M.D.
• Joyce Maxon
• Taylor Maxwell-Thomas

• Dermatology Physician in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.