Active NPI
Matthew McKissick, DDS
- Dentist
- Clearfield, PA
National Provider Identifier
1396953576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS037094
- Practice address
- 720 Turnpike Ave
Clearfield, PA 16830-1231 - Phone
- (814) 765-3631
- NPI assigned
- May 19, 2007
- Last updated
- Nov 4, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS037094 | PA | Primary |
Addresses
Primary practice location
720 Turnpike Ave
Clearfield, PA 16830-1231
Mailing address
731 Old Town Rd
Clearfield, PA 16830-1903
Phone (814) 765-9563
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160114000844 | PA | Order and Referring Only - Oral Surgery | 8426351024 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS037094 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257292800000",
"number": "1396953576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 OLD TOWN RD",
"city": "CLEARFIELD",
"state": "PA",
"postal_code": "168301903",
"telephone_number": "814-765-9563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 TURNPIKE AVE",
"city": "CLEARFIELD",
"state": "PA",
"postal_code": "168301231",
"telephone_number": "814-765-3631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKISSICK",
"first_name": "MATTHEW",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-19",
"last_updated": "2009-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS037094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearfield, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.