Matthew Scott Standridge, D.D.S.

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

60776 Issued in KS

Practice address

1 Southtowne Dr
Potosi, MO 63664-5729

Phone

(573) 438-8401

NPI assigned

May 25, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Other, 2010

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Southeast Kansas Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Humboldt, KS
  • NPI 1467414771
  Medicare reassignment NPD
• Yates Center Dental LLC

  • General Practice Dentistry
  • Yates Center, KS
  • NPI 1538558135
  NPD (past) Authorized official

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

{
    "created_epoch": "1274745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312502400000",
    "number": "1255650529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W 15TH AVE",
            "city": "EMPORIA",
            "state": "KS",
            "postal_code": "668015367",
            "telephone_number": "620-342-4864",
            "fax_number": "620-342-7790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SOUTHTOWNE DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636645729",
            "telephone_number": "573-438-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANDRIDGE",
        "first_name": "MATTHEW",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-25",
        "last_updated": "2011-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "MO",
            "license": "2010016150",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "KS",
            "license": "60776",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Simpelo Medi-Spa
• Simpelo Medical Clinic, P.C.
• Rustico V Simpelo, MD
• Brett T Snodgrass, MD
• Southtowne Imaging Center LLC
• Vonna Suda, EDS
• Bobbi J Summers, LPC
• Gregory Keith Terpstra, DO
• Jeffrey Paul Tindall, DO
• Tricorex Inc.

• Public Health Dentistry in Potosi, MO
• Providers in Potosi, MO by specialty
• Public Health Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.