Individual provider Active NPI

Matthew Aaron Cody Davis, PHD

  • Psychologist
  • Louisville, KY
National Provider Identifier
1447836580
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
262369 Issued in KY
Practice address
1405 E Burnett Ave
Louisville, KY 40217-1577
Phone
(502) 350-0575
NPI assigned
Mar 19, 2021
Last updated
Dec 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 262369 KY Primary

Addresses

Primary practice location

1405 E Burnett Ave
Louisville, KY 40217-1577

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

Other identifiers 2

IdentifierTypeStateIssuer
K377650OtherKYKENTUCKY MEDICARE
7100731310MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210415000114 KY Practitioner - Clinical Psychologist 8628486487 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
262369KYMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children's Medical Group, LLC Psychologist Current Accepting new patients
Norton Children's Medical Group, LLC CurrentSince Jun 1, 2021 Accepting new patients
Norton Children's Medical Group, LLC CurrentSince Jun 1, 2021 Accepting new patients

Locations

202 Limestone St S
Ste 1A
Frankfort, KY 40601
Phone (502) 223-8400

1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000

1405 E Burnett Ave
Louisville, KY 40217
Phone (502) 473-7219

2933 Breckenridge Ln
Ste 101
Louisville, KY 40220
Phone (502) 588-0736

411 E Chestnut St
Louisville, KY 40202
Phone (502) 588-2330

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

Interoperability endpoints

  • Direct secure messaging: mdavis209012@direct.nortonhealthcare.org

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, 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": "1616112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1447836580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 E BURNETT AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171577",
            "telephone_number": "502-350-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MATTHEW",
        "middle_name": "AARON CODY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-19",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KY",
            "license": "262369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY MEDICARE",
            "identifier": "K377650",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100731310",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.