NPIMap

Individual provider Active NPI

Matthew Ryan Mabie, RPH

  • Pharmacist
  • Cottage Grove, WI
National Provider Identifier
1396788741
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
12888 Issued in WI
Practice address
429 W Cottage Grove Rd
Cottage Grove, WI 53527-9385
Phone
(608) 839-3335
Fax
(608) 839-3336
NPI assigned
Jun 14, 2006
Last updated
Aug 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 12888 WI Primary

Addresses

Primary practice location

429 W Cottage Grove Rd
Cottage Grove, WI 53527-9385

Mailing address

2108 Uphoff Rd
Cottage Grove, WI 53527-9475
Phone (608) 347-5420

Other identifiers 1

IdentifierTypeStateIssuer
12888-040OtherWISTATE PHARMACIST LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Blumon Corporation Current Accepting new patients

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1396788741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 UPHOFF RD",
            "city": "COTTAGE GROVE",
            "state": "WI",
            "postal_code": "535279475",
            "telephone_number": "608-347-5420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 W COTTAGE GROVE RD",
            "city": "COTTAGE GROVE",
            "state": "WI",
            "postal_code": "535279385",
            "telephone_number": "608-839-3335",
            "fax_number": "608-839-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABIE",
        "first_name": "MATTHEW",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "12888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACIST LICENSE",
            "identifier": "12888-040",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottage Grove, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.