NPIMap

Individual provider Active NPI

Matthew Jude Mutter, MD

  • Urology Physician
  • Memphis, TN
National Provider Identifier
1417272063
Registry record updated Jun 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
52976 Issued in TN
Practice address
880 Madison Ave
Memphis, TN 38103-3409
Phone
(901) 545-6969
Fax
(901) 545-7260
NPI assigned
Apr 6, 2010
Last updated
Jun 17, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Urology Physician 208800000X 52976 TN Primary

Addresses

Primary practice location

880 Madison Ave
Memphis, TN 38103-3409

Mailing address

877 Jefferson Ave
Attn: Provider Enrollment
Memphis, TN 38103-2807
Phone (901) 545-7302

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20160526000200 LA Practitioner - Urology 2264679810 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Louisiana State University School of Medicine in New Orleans, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mary Bird Perkins Cancer CenterGroup PAC ID 4385646280, 95 clinicians
Hawkeye Medical, LLCGroup PAC ID 9032254685, 33 clinicians
CLHG-Avoyelles LLCGroup PAC ID 8921380528, 39 clinicians

Practice addresses (Care Compare)

2800 Veterans Memorial Blvd
Suite 140
Metairie, LA 70002-6139
Phone (225) 767-0847

4231 Hwy 1192
Marksville, LA 71351-4711
Phone (318) 240-6000

4239 Hwy 1192
Marksville, LA 71351-4772
Phone (318) 253-8611

5541 Hwy 1
Marksville, LA 71351-2650
Phone (318) 240-7240

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
CLHG-Avoyelles LLC CurrentSince Mar 7, 2024 Accepting new patients
Mary Bird Perkins Cancer Center CurrentSince Jan 1, 2025 Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G CurrentSince Jul 13, 2016 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G Current Accepting new patients
CLHG-Avoyelles LLC Current Accepting new patients
Louisiana State University School of Medicine in New Orleans Faculty G CurrentSince Jul 13, 2016 Accepting new patients
CLHG-Avoyelles LLC CurrentSince Mar 7, 2024 Accepting new patients
Hawkeye Medical, LLC CurrentSince Apr 9, 2024 Accepting new patients

Locations

2906 Main St
Hessmer, LA 71341
Phone (318) 315-7093

1610 Water St
Lecompte, LA 71346
Phone (318) 406-8010

4231 Highway 1192
Marksville, LA 71351
Phone (318) 240-6000

4239 Highway 1192
Ste 300
Marksville, LA 71351
Phone (318) 253-0677

5541 Highway 1
Marksville, LA 71351
Phone (318) 240-7240

2800 Veterans Memorial Blvd
Ste 140
Metairie, LA 70002
Phone (225) 767-0847

10542 Highway 1
Moreauville, LA 71355
Phone (318) 785-0102

1542 Tulane Ave
New Orleans, LA 70112
Phone (504) 866-2741

1542 Tulane Ave
Ste 659
New Orleans, LA 70112
Phone (504) 568-2314

2832 Burdette St
New Orleans, LA 70125
Phone (504) 866-2741

4950 Essen Ln
St George, LA 70809
Phone (225) 767-0847

Interoperability endpoints

  • Direct secure messaging: matthew.mutter.1@16696.direct.athenahealth.com
  • Direct secure messaging: matthew.mutter.2@30808.direct.athenahealth.com
  • Direct secure messaging: matthewmutter@nmhs.medalliesdirect.net

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.

Hospital & facility affiliations 6

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": "1270512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434499200000",
    "number": "1417272063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "address_2": "ATTN: PROVIDER ENROLLMENT",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-545-7302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033409",
            "telephone_number": "901-545-6969",
            "fax_number": "901-545-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTTER",
        "first_name": "MATTHEW",
        "middle_name": "JUDE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-06",
        "last_updated": "2015-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TN",
            "license": "52976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.