Mattie White, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2008014947 Issued in MO

Practice address

3197 Portis Ave
Saint Louis, MO 63116-2023

Phone

(618) 713-3847

NPI assigned

Feb 20, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1316912892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3197 PORTIS AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631162023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3197 PORTIS AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631162023",
            "telephone_number": "618-713-3847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "MATTIE",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-20",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2008014947",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036103546",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316912892",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GROUP NUMBER",
            "identifier": "CB3700",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "659580",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00189155",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA PIN",
            "identifier": "K04489",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "10007459",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036103546",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK PROV NUMBER",
            "identifier": "460661",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay White, FNP
• Lisa Elaine White, LPC
• Lynn K White, MD
• Mackenzie White, PHARMD
• Matinah White
• Megan Elizabeth White, MD
• Megan Marie White, LMSW
• Monica Lynnette White, MA
• Neil H White, MD
• Patrick Hodge White, MD

• Family Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.