NPIMap

Individual provider Active NPI

Matheis W Carrico, MD

  • Internal Medicine Physician
  • Owensboro, KY
National Provider Identifier
1962499624
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
39371 Issued in KY
Practice address
3346 Professional Park Dr
Owensboro, KY 42303-4551
Phone
(270) 685-1066
Fax
(270) 685-0881
NPI assigned
Sep 28, 2005
Last updated
Mar 23, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 39371 KY Primary

Addresses

Primary practice location

3346 Professional Park Dr
Owensboro, KY 42303-4551

Mailing address

3346 Professional Park Dr
Owensboro, KY 42303-4551
Phone (270) 685-1066

Other identifiers 4

IdentifierTypeStateIssuer
369694OtherKYBLUE CROSS
20524260MedicaidIN
50007250OtherKYPASS PORT
64098486MedicaidKY

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
I20050602000558 KY Practitioner - Internal Medicine 7416990395 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kentucky College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Owensboro Health, IncGroup PAC ID 0547154650, shared by 9 NPIs, 179 clinicians
Bluegrass Internal Medicine PLLCGroup PAC ID 1254316821, 8 clinicians

Practice addresses (Care Compare)

1006 Ford Ave
Owensboro, KY 42301-4677
Phone (270) 688-4845

3346 Professional Park
Owensboro, KY 42303-4551
Phone (270) 683-1066

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Owensboro Health Medical Group Inc Current Accepting new patients
Owensboro Health Medical Group Inc Internal Medicine CurrentSince Jan 14, 2022 Accepting new patients
Owensboro Health Medical Group, Inc Internal Medicine CurrentSince Jan 14, 2022 Accepting new patients
Bluegrass Internal Medicine PLLC Internal Medicine CurrentSince Jul 1, 2005 Accepting new patients

Locations

2211 Mayfair Dr
Ste 101
Owensboro, KY 42301
Phone (270) 688-1352

2211 Mayfair Dr
Ste 102
Owensboro, KY 42301
Phone (270) 688-1351

3346 Professional Park
Owensboro, KY 42303
Phone (270) 683-1066

Interoperability endpoints

  • Direct secure messaging: mcarrico204516@direct.deaconess.com

Organizations & group practices 4

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

Hospital & facility affiliations 9

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": "1127865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1962499624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3346 PROFESSIONAL PARK DR",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423034551",
            "telephone_number": "270-685-1066",
            "fax_number": "270-685-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3346 PROFESSIONAL PARK DR",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423034551",
            "telephone_number": "270-685-1066",
            "fax_number": "270-685-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRICO",
        "first_name": "MATHEIS",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-28",
        "last_updated": "2012-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "39371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "369694",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20524260",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASS PORT",
            "identifier": "50007250",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64098486",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owensboro, KY

Sources for this page

Verify at the official NPI Registry.