Individual provider Active NPI

Renee Marie Mathew, APRN

  • Nurse Practitioner
  • Edgewood, KY
National Provider Identifier
1548517956
Registry record updated Dec 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3007600 Issued in KY
Practice address
1 Medical Village Dr
Edgewood, KY 41017-3403
Phone
(859) 301-4000
Fax
(859) 301-4001
NPI assigned
Aug 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3007600 KY Primary

Addresses

Primary practice location

1 Medical Village Dr
Edgewood, KY 41017-3403

Mailing address

PO Box 636324
Cincinnati, OH 45263-6324
Phone (859) 301-4000

Other practice location 1

1500 James Simpson Jr Way
Covington, KY 41011-0801
Phone (859) 655-4353

Other practice location 2

238 Barnes Rd
Williamstown, KY 41097-9482
Phone (859) 824-8240

Other practice location 3

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-2250

Other identifiers 2

IdentifierTypeStateIssuer
7100219530MedicaidKY
0224891MedicaidOH

Other names 1

  • Renee M Black Former name

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150403000594 KY Practitioner - Nurse Practitioner 5799003687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Elizabeth Medical Center, IncGroup PAC ID 0648174623, 187 clinicians

Practice addresses (Care Compare)

1 Medical Village Dr
Edgewood, KY 41017-3403
Phone (859) 301-4723

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3007600KYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Elizabeth Medical Center, Inc CurrentSince Dec 16, 2025 Accepting new patients
St Elizabeth Medical Center, Inc Nurse Practitioner CurrentSince Dec 16, 2025 Accepting new patients

Locations

1500 James Simpson Jr Way
Covington, KY 41011
Phone (859) 655-4353

1 Medical Village Dr
Edgewood, KY 41017
Phone (859) 301-2000

85 N Grand Ave
Fort Thomas, KY 41075
Phone (859) 572-3100

238 Barnes Rd
Williamstown, KY 41097
Phone (859) 292-4000

Organizations & group practices 2

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

Hospital & facility affiliations 1

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": "1344211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764547200000",
    "number": "1548517956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636324",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636324",
            "telephone_number": "859-301-4000",
            "fax_number": "859-301-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-4000",
            "fax_number": "859-301-4001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 James Simpson Jr Way",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "KY",
            "postal_code": "410110801",
            "country_code": "US",
            "telephone_number": "859-655-4353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "238 Barnes Rd",
            "address_purpose": "LOCATION",
            "city": "Williamstown",
            "state": "KY",
            "postal_code": "410979482",
            "country_code": "US",
            "telephone_number": "859-824-8240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Village Dr",
            "address_purpose": "LOCATION",
            "city": "Edgewood",
            "state": "KY",
            "postal_code": "410173403",
            "country_code": "US",
            "telephone_number": "859-301-2250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "RENEE",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-06",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3007600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100219530",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0224891",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENEE",
            "last_name": "BLACK",
            "middle_name": "M",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Edgewood, KY

Sources for this page

Verify at the official NPI Registry.