Katherine Ann Mattingly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50002181 Issued in OH

Practice address

122 Wyoming St
Dayton, OH 45409-2731

Phone

(937) 223-4461

Fax

(937) 224-1945

NPI assigned

Jul 18, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
  • NPI 1194958223

  Physician Assistant

  Medicare reassignment NPD
• Premier Health Specialists Inc

  • Foot & Ankle Surgery Podiatrist
  • Dayton, OH
  • NPI 1902211287
  NPD
• Miami Valley Cardiologists Inc.

  • Cardiovascular Disease Physician
  • Dayton, OH
  • NPI 1538168083
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390867200000",
    "number": "1699774174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092731",
            "telephone_number": "937-223-4461",
            "fax_number": "937-224-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092731",
            "telephone_number": "937-223-4461",
            "fax_number": "937-224-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "KATHERINE",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-18",
        "last_updated": "2014-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50002181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0067797",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Matthews, LPN
• Rachel Beth Matthews, D.O.
• Scottesha Matthews
• Stanley Gordon Matthews, D.D.S.
• Corrie Matthias, AGACNP-BC
• James Mattocks, MS, ATC, CSCS
• Jeremy Christopher Mauldin, D.O.
• Lindsey E Mauntel, RD, LD
• Benjamin Mauntler, CDCA
• Daniel Wayne Maupin, CDCA PRELIMINARY

• Physician Assistant in Dayton, OH
• Providers in Dayton, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.