NPIMap

Individual provider Active NPI

Douglas E Mattingly, M.D.

  • Family Medicine Physician
  • Louisville, KY
National Provider Identifier
1801851886
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34540 Issued in KY
Practice address
947 Eastern Pkwy
Louisville, KY 40217-1573
Phone
(502) 361-8801
Fax
(502) 361-8821
NPI assigned
Apr 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34540 KY Primary

Addresses

Primary practice location

947 Eastern Pkwy
Louisville, KY 40217-1573

Mailing address

3202 Thousand Oaks Dr
Louisville, KY 40205-2703
Phone (502) 361-8801

Other identifiers 1

IdentifierTypeStateIssuer
64345408MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Douglas.Mattingly@196870797983748.direct.elationemr.com DMMD Concierge LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20040706000214 KY Practitioner - Family Practice 1850378142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kentucky College of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
DMMD Concierge LLCGroup PAC ID 0244665412, 2 clinicians

Practice addresses (Care Compare)

947 Eastern Pkwy
Louisville, KY 40217-1573
Phone (502) 361-8801

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions15
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
DMMD Concierge LLC Family Medicine CurrentSince Jan 2, 2020 Accepting new patients
University of Louisville Research Foundation Family Medicine Past Accepting new patients
University Family Practice Assoc. PSC Family Medicine Past Accepting new patients

Locations

947 Eastern Pkwy
Louisville, KY 40217
Phone (502) 361-8801

Interoperability endpoints

  • Direct secure messaging: douglas.mattingly@196870797983748.direct.elationemr.com

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 and National Provider Directory roles.

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1801851886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3202 THOUSAND OAKS DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052703",
            "telephone_number": "502-361-8801",
            "fax_number": "502-361-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "947 EASTERN PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171573",
            "telephone_number": "502-361-8801",
            "fax_number": "502-361-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "DOUGLAS",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "34540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64345408",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Douglas.Mattingly@196870797983748.direct.elationemr.com",
            "affiliation": "Y",
            "affiliationName": "DMMD Concierge LLC",
            "address_1": "947 Eastern Pkwy",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402171573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.