Matt Fanning, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2020022837 Issued in MO

Practice address

1 Brookings Drive
Seigle Hall, Ste 435
St. Louis, MO 63130-4889

Phone

(314) 935-8457

NPI assigned

Aug 12, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vivent Health IncGroup PAC ID 1052308376, 54 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mfanning734039@direct.ochin.org

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.

• Vivent Health Inc

  • Clinic/Center
  • Milwaukee, WI
  • NPI 1982654091

  MO

  Medicare reassignment Care Compare group NPD
• Vivent Health Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1770721607
  NPD
• Behavioral Health Response, Inc

  • Counselor
  • Saint Louis, MO
  • NPI 1023546967
  NPD (past)

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

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1265043376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4049 W PINE BLVD APT 103",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083237",
            "telephone_number": "314-372-9738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BROOKINGS DRIVE",
            "address_2": "SEIGLE HALL, STE 435",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "631304889",
            "telephone_number": "314-935-8457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4049 W Pine Blvd Apt 103",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631083237",
            "country_code": "US",
            "telephone_number": "314-372-9738",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12647 Olive Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631416345",
            "country_code": "US",
            "telephone_number": "314-469-4908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANNING",
        "first_name": "MATT",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-12",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2020022837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Danni Fan
• Lea Fang, OTR
• Teri Fanizza
• Katherine Fann, MS, RD, LD, CSWOMCDE
• Hallie Rae Fanning, PHARM. D
• Carmen Fanous, MD
• Cynthia Fantini
• Donna Fantozzi, LPC
• Faquir Muhammud, MD, Inc
• Joanna Marie Farache

• Clinical Social Worker in St. Louis, MO
• Providers in St. Louis, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.