Individual provider Active NPI

Mattias Dino D'Anna, DO

  • Family Medicine Physician
  • Independence, MO
National Provider Identifier
1205451655
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2023010864 Issued in MO
Practice address
19600 E 39TH St S
Independence, MO 64057-2301
Phone
(913) 222-9779
NPI assigned
Jun 11, 2020
Last updated
Aug 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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 2023010864 MO Primary

Addresses

Primary practice location

19600 E 39TH St S
Independence, MO 64057-2301

Mailing address

19600 E 39TH St S
Independence, MO 64057-2301
Phone (913) 222-9779

Other practice location 1

2100 SE Blue Pkwy
Lees Summit, MO 64063-1007
Phone (816) 282-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230829000433 MO Practitioner - Internal Medicine 6709205222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pandc Healthcare LLCGroup PAC ID 3779861109, 38 clinicians

Practice addresses (Care Compare)

19600 E 39TH St S
Independence, MO 64057-2301
Phone (913) 222-9779

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023010864MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
P&C Healthcare LLC CurrentSince Oct 1, 2023 Accepting new patients
P & C Consultant Services Past Accepting new patients
Centerpoint Medical Center of Independence, LLC Past Accepting new patients

Locations

19600 E 39th St S
Independence, MO 64057
Phone (816) 698-7000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DHAEDD

Organizations & group practices 3

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 1

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": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1205451655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19600 E 39TH ST S",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572301",
            "telephone_number": "913-222-9779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19600 E 39TH ST S",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572301",
            "telephone_number": "913-222-9779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 SE Blue Pkwy",
            "address_purpose": "LOCATION",
            "city": "Lees Summit",
            "state": "MO",
            "postal_code": "640631007",
            "country_code": "US",
            "telephone_number": "816-282-5000",
            "fax_number": "913-498-6708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "D'ANNA",
        "first_name": "MATTIAS",
        "middle_name": "DINO",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-11",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2023010864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

Verify at the official NPI Registry.