NPIMap

Organization Active NPI

Abode Care Partners LTC VB, LLC

  • Nurse Practitioner
  • Mountain City, TN
National Provider Identifier
1972372225
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ABODE CARE PARTNERS LTC VB, LLC
Practice address
919 Medical Park Dr
Mountain City, TN 37683-1042
Phone
(800) 807-6555
Fax
(855) 316-2999
NPI assigned
Dec 28, 2023
Last updated
Jun 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

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

Authorized official

Name
Angie Mattingly
Title
MGR Provider Enrollment
Phone
(502) 420-2512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

919 Medical Park Dr
Mountain City, TN 37683-1042

Mailing address

805 N Whittington Pkwy
Louisville, KY 40222-7101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240129001302 TN Part B Supplier - Clinic/Group Practice 8325316516 Receives reassigned benefits from 46 practitioners
Practice locations: Mountain City, TN

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1703721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780272000000",
    "number": "1972372225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N WHITTINGTON PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402227101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 MEDICAL PARK DR",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376831042",
            "telephone_number": "800-807-6555",
            "fax_number": "855-316-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABODE CARE PARTNERS LTC VB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-28",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A",
        "authorized_official_last_name": "MATTINGLY",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "MGR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "502-420-2512"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountain City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.