NPIMap

Individual provider Active NPI

Matthew Cianciolo, DO

  • Family Medicine Physician
  • Lees Summit, MO
National Provider Identifier
1053362681
Registry record updated Feb 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2006004613 Issued in MO
Practice address
20 NE Saint Lukes Blvd
Ste. 200
Lees Summit, MO 64086-6001
Phone
(813) 347-5100
Fax
(816) 347-5136
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2018

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 2006004613 MO Primary

Addresses

Primary practice location

20 NE Saint Lukes Blvd
Ste. 200
Lees Summit, MO 64086-6001

Mailing address

901 E. 104TH St.
Mailstop 400N
Kansas City, MO 64131-9712
Phone (816) 502-7104

Other identifiers 1

IdentifierTypeStateIssuer
1053362681MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20060808000322 MO Practitioner - Family Practice 9638172836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Lukes Physician Group IncGroup PAC ID 3577476894, 1,233 clinicians

Practice addresses (Care Compare)

20 NE Saint Lukes Blvd
Lee'S Summit, MO 64086-6001

601 S 169 Hwy
Smithville, MO 64089-9317
Phone (816) 532-3700

601 S US Hwy 169
Smithville, MO 64089-9317
Phone (816) 532-3999

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
2006004613MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Luke'S Physician Group Inc Family Medicine CurrentSince Mar 1, 2017 Accepting new patients
Saint Luke'S Neighborhood Clinics, LLC Past Accepting new patients

Locations

1307 E North Ave
Belton, MO 64012
Phone (816) 251-5765

901 E 104th St
#400N
Kansas City, MO 64131
Phone (816) 502-8756

20 NE Saint Lukes Blvd
Ste 350
Lees Summit, MO 64086
Phone (816) 347-5600

20 NE Saint Lukes Blvd
Ste 200
Lees Summit, MO 64086
Phone (816) 347-5100

2703 Running Horse Rd
Platte City, MO 64079
Phone (816) 858-3250

601 S US Highway 169
Smithville, MO 64089
Phone (816) 532-3999

Networks

  • IA HMO C-SNP
  • IA HMO

Interoperability endpoints

  • Direct secure messaging: mcianciolo96475@direct.saint-lukes.org

Organizations & group practices 2

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 7

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519257600000",
    "number": "1053362681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 E. 104TH ST.",
            "address_2": "MAILSTOP 400N",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641319712",
            "telephone_number": "816-502-7104",
            "fax_number": "816-932-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 NE SAINT LUKES BLVD",
            "address_2": "STE. 200",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640866001",
            "telephone_number": "813-347-5100",
            "fax_number": "816-347-5136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIANCIOLO",
        "first_name": "MATTHEW",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2006004613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053362681",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lees Summit, MO

Sources for this page

Verify at the official NPI Registry.