THERESA KATHERINE MATTINGLY (M.D.) – Dermatology Physician, NPI 1265849053
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
703 DERMATOLOGY in IL
Provider Addresses for THERESA KATHERINE MATTINGLY (M.D.)
PO BOX 19644
SPRINGFIELD, IL 627949644
Phone:
Type: Mailing
751 N RUTLEDGE ST STE 2300
SPRINGFIELD, IL 627024968
Phone: (217) 545-7438
Type: Location
3265 NE RALPH POWELL RD
LEES SUMMIT, MO 640642301
Phone: (816) 524-4747
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 107 Open Payments records for all available years, with a total value of $1,841.
Total Amount is formed as General ($1,841) + Research ($0) + Ownership ($0) = $1,841.
Last reported payment date: 2024-12-17 • Largest payer in this snapshot: ABBVIE INC. ($656).
Total Amount
$1,841
General + Research + Ownership
Payments
107
Total payment records
General Amount
$1,841
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-17
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $656 |
| Novartis Pharmaceuticals Corporation | $440 |
| Dermavant Sciences, Inc. | $362 |
| Amgen Inc. | $86 |
| E.R. Squibb & Sons, L.L.C. | $53 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2018-07-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20180720000298 | I | Dermatology | MO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 1,936 | 299 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 622 | 461 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 470 | 346 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 358 | 243 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 347 | 297 | $0 |
Insurance plans in this area (ZIP 62794)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| D E R M A T O L O G Y | MO | |
| D E R M A T O L O G Y | FL | |
| Physician Assistant | MO | |
| Nurse Practitioner | MO |
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