Individual provider Active NPI

McKayla M Dinwiddie, MD

  • Family Medicine Physician
  • O Fallon, MO
National Provider Identifier
1194429290
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2026028283 Issued in MO
Practice address
2299 Technology Dr Ste 320
O Fallon, MO 63368-7341
Phone
(636) 695-0535
Fax
(636) 695-0537
NPI assigned
Mar 30, 2023
Sex
Female
Sole proprietor
No

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20230621001669 WI Order and Referring Only - Family PracticePractitioner - Family Practice 3870951015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2026028283 MO Primary
Family Medicine Physician 207Q00000X 100277 WI
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

NPPES NPI Registry

Primary practice location

2299 Technology Dr Ste 320
O Fallon, MO 63368-7341

Mailing address

PO Box 959354
Saint Louis, MO 63195-9354
Phone (636) 695-0535

Other practice location 1

800 West Ave S
LA Crosse, WI 54601-8806
Phone (608) 785-0940

Electronic endpoints 2

NPPES NPI Registry
TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE)
Direct Messaging Address mdinwiddie1950128@ehrdirect.mayoclinicmsg.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 30, 2026.

{
    "created_epoch": "1680134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1194429290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631959354",
            "telephone_number": "636-695-0535",
            "fax_number": "636-695-0537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2299 TECHNOLOGY DR STE 320",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633687341",
            "telephone_number": "636-695-0535",
            "fax_number": "636-695-0537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 West Ave S",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546018806",
            "country_code": "US",
            "telephone_number": "608-785-0940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DINWIDDIE",
        "first_name": "MCKAYLA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-30",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2026028283",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "100277",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2299 Technology Dr Ste 320",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633687341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdinwiddie1950128@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "800 West Ave S",
            "city": "LA Crosse",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546018806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

Verify at the official NPI Registry.