NPIMap

Individual provider Active NPI

Amanda Mattingly, FNP-C

  • Family Nurse Practitioner
  • Washington, IN
National Provider Identifier
1457718389
Registry record updated Mar 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71006023A Issued in IN
Practice address
2005 State St
Suite a
Washington, IN 47501-8559
Phone
(812) 254-4650
Fax
(812) 254-4081
NPI assigned
Jan 22, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71006023A IN Primary

Addresses

Primary practice location

2005 State St
Suite a
Washington, IN 47501-8559

Mailing address

2005 State St
Suite a
Washington, IN 47501-8559
Phone (812) 254-4650

Other identifiers 3

IdentifierTypeStateIssuer
1038335OtherINANTHEM
201347470MedicaidIN
258190072OtherINMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20160318000045 IN Practitioner - Nurse Practitioner 9830496843 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2005 State St
Suite a
Washington, IN 47501-8559
Phone (812) 254-4650

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital Physicians Services Inc CurrentSince Feb 13, 2016 Accepting new patients
Good Samaritan Hospital Physician Services, Inc Current Accepting new patients
Good Samaritan Hospital CurrentSince Feb 13, 2016 Accepting new patients
Good Samaritan Hospital Physician Services Inc. Past Accepting new patients

Locations

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

1813 Willow St
Ste 3
Vincennes, IN 47591
Phone (812) 885-8941

2005 State St
Ste A
Washington, IN 47501
Phone (812) 254-4650

Organizations & group practices 4

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 8

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": "1453420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520294400000",
    "number": "1457718389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 STATE ST",
            "address_2": "SUITE A",
            "city": "WASHINGTON",
            "state": "IN",
            "postal_code": "475018559",
            "telephone_number": "812-254-4650",
            "fax_number": "812-254-4081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 STATE ST",
            "address_2": "SUITE A",
            "city": "WASHINGTON",
            "state": "IN",
            "postal_code": "475018559",
            "telephone_number": "812-254-4650",
            "fax_number": "812-254-4081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "AMANDA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-22",
        "last_updated": "2018-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71006023A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "1038335",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201347470",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "258190072",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, IN

Sources for this page

Verify at the official NPI Registry.