Active NPI
Michael T Mattingly, MD
- Nephrology Physician
- Greensboro, NC
National Provider Identifier
1477592673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 9500996
- Practice address
- 309 New St
Greensboro, NC 27405-3654 - Phone
- (336) 379-9708
- Fax
- (336) 379-8714
- NPI assigned
- Jun 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 9500996 | NC | Primary |
Addresses
Primary practice location
309 New St
Greensboro, NC 27405-3654
Mailing address
309 New St
Greensboro, NC 27405-3654
Phone (336) 379-9708
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 390004560 | Other | NC | RRM PROVIDER # |
| 19495 | Other | NC | PARTNERS |
| 1036N | Other | NC | BCBS PROVIDER # |
| 561274347 | Other | NC | CKA'S TAX ID # |
| 891036N | Medicaid | NC | |
| 3102727 | Other | NC | UHC PROVIDER # |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9500996 | NC | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369008000000",
"number": "1477592673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 NEW ST",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274053654",
"telephone_number": "336-379-9708",
"fax_number": "336-379-8714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 NEW ST",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274053654",
"telephone_number": "336-379-9708",
"fax_number": "336-379-8714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTINGLY",
"first_name": "MICHAEL",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2013-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "NC",
"license": "9500996",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRM PROVIDER #",
"identifier": "390004560",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "19495",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "1036N",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CKA'S TAX ID #",
"identifier": "561274347",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891036N",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC PROVIDER #",
"identifier": "3102727",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.