NPIMap

Individual provider Active NPI

Patrick M Matthiessen, MD

  • Neurology Physician
  • La Grange, KY
National Provider Identifier
1306833124
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
01074910A Issued in IN
Practice address
1009 New Moody LN
La Grange, KY 40031-9142
Phone
(502) 222-8503
NPI assigned
Oct 6, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 01074910A IN Primary

Addresses

Primary practice location

1009 New Moody LN
La Grange, KY 40031-9142

Mailing address

5200 Commerce Crossings Dr FL 3
Louisville, KY 40229-2182
Phone (502) 253-4900

Other practice location 1

101 Stonecrest Rd Ste 2
Shelbyville, KY 40065-8169
Phone (502) 222-8503

Other identifiers 5

IdentifierTypeStateIssuer
915174OtherINANTHEM
50084197OtherKYPASSPORT
7100347060MedicaidKY
201274940MedicaidIN
7494410OtherINAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150302001562 IN Practitioner - Neurology 7517007974 Reassigns benefits to 1 organization
I20220923002343 KY Practitioner - Neurology 7517007974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Louisville School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians
PT Pros, IncGroup PAC ID 0143139337, 263 clinicians

Practice addresses (Care Compare)

101 Stonecrest Rd
Suite 2
Shelbyville, KY 40065-8169
Phone (502) 225-9877

4031 N Dixie Hwy
Elizabethtown, KY 42701-7873
Phone (270) 982-4776

Hospital & facility affiliations

  • Baptist Health Lagrange Hospital, La Grange, KY, CCN 180138
  • Baptist Health Louisville Hospital, Louisville, KY, CCN 180130
  • Baptist Health Hardin Hospital, Elizabethtown, KY, CCN 180012
  • Norton-King'S Daughters' Health Hospital, Madison, IN, CCN 150069
  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01074910AINMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Sep 9, 2022 Accepting new patients
Norton - Kings Daughters Health Inc CurrentSince Mar 2, 2015 Accepting new patients
Norton - Kings Daughters Health Inc CurrentSince Mar 2, 2015 Accepting new patients
Tristate Pathology and Forensic Services LLC Current Accepting new patients
Baptist Health Medical Group Inc Neurology CurrentSince Sep 9, 2022 Accepting new patients
Roane County Medical Center Past Accepting new patients
W E Bennett MD Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

630 Broadway St
Madison, IN 47250
Phone (812) 265-0801

1373 N State Road 62
Madison, IN 47250
Phone (812) 801-0196

1009 New Moody Ln
Lagrange, KY 40031
Phone (502) 222-3927

5200 Commerce Crossings Dr
Fl 3
Louisville, KY 40229
Phone (502) 253-4924

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

101 Stonecrest Rd
Ste 2
Shelbyville, KY 40065
Phone (502) 647-0311

Organizations & group practices 22

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.

View all 22

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670803200000",
    "number": "1306833124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 COMMERCE CROSSINGS DR FL 3",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402292182",
            "telephone_number": "502-253-4900",
            "fax_number": "502-489-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 NEW MOODY LN",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400319142",
            "telephone_number": "502-222-8503"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Stonecrest Rd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Shelbyville",
            "state": "KY",
            "postal_code": "400658169",
            "country_code": "US",
            "telephone_number": "502-222-8503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTHIESSEN",
        "first_name": "PATRICK",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "01074910A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "915174",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50084197",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100347060",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201274940",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7494410",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange, KY

Sources for this page

Verify at the official NPI Registry.