Active NPI
Jonathan Robert Mattingly
- General Practice Physician
- Louisville, KY
National Provider Identifier
1962105833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- R7408
- Practice address
- 500 S Preston St
Louisville, KY 40202-1702 - Phone
- (502) 852-5193
- NPI assigned
- Mar 22, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | R7408 | KY | Primary |
Addresses
Primary practice location
500 S Preston St
Louisville, KY 40202-1702
Mailing address
7805 Binford Way
Louisville, KY 40291-5279
Phone (502) 489-4641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788912000000",
"number": "1962105833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7805 BINFORD WAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402915279",
"telephone_number": "502-489-4641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S PRESTON ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402021702",
"telephone_number": "502-852-5193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTINGLY",
"first_name": "JONATHAN",
"middle_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-03-22",
"last_updated": "2026-09-09",
"certification_date": "2026-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "KY",
"license": "R7408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; 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.