Individual provider Active NPI

Melissa I Dimmitt, LMSW

  • Clinical Social Worker
  • Kirksville, MO
National Provider Identifier
1447806906
Registry record updated Aug 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2019029632 Issued in MO
Practice address
105 Pfeiffer Ave
Kirksville, MO 63501-5047
Phone
(660) 665-4612
Fax
(660) 665-4635
NPI assigned
Aug 12, 2019
Last updated
Aug 12, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2019029632 MO Primary

Addresses

Primary practice location

105 Pfeiffer Ave
Kirksville, MO 63501-5047

Mailing address

105 Pfeiffer Ave
Kirksville, MO 63501-5047
Phone (660) 665-4612

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201119000094 MO Practitioner - Clinical Social Worker 8921419110 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Missouri Health Council, Inc. Clinical Current Accepting new patients

Locations

1416 Crown Dr
Kirksville, MO 63501
Phone (660) 627-4493

1506 Crown Dr
Kirksville, MO 63501
Phone (660) 627-4493

402 W Jefferson St
Kirksville, MO 63501
Phone (660) 665-2741

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1447806906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 PFEIFFER AVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635015047",
            "telephone_number": "660-665-4612",
            "fax_number": "660-665-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PFEIFFER AVE",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635015047",
            "telephone_number": "660-665-4612",
            "fax_number": "660-665-4635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMMITT",
        "first_name": "MELISSA",
        "middle_name": "I",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2019029632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirksville, MO

Sources for this page

Verify at the official NPI Registry.