Pathamas Chantaracherd Mittman, DDS, MS

Primary specialty

Orofacial Pain DentistryTaxonomy code 1223X2210X

License

S187 Issued in MN

Practice address

3475 Plymouth Blvd Ste 200
Plymouth, MN 55447-1539

Phone

(763) 577-2484

Fax

(763) 577-1375

NPI assigned

Sep 13, 2022

Last updated

Sep 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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 MN

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minnesota Head and Neck Pain Clinic PAGroup PAC ID 2769453687, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pathamas.mittman.1@13597.direct.athenahealth.com

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.

• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • Saint Paul, MN
  • NPI 1104850155
  Medicare reassignment Care Compare group NPD
• Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • Burnsville, MN
  • NPI 1255715181
  NPD

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1447972922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 PLYMOUTH BLVD STE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471539",
            "telephone_number": "763-577-2484",
            "fax_number": "763-577-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 PLYMOUTH BLVD STE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471539",
            "telephone_number": "763-577-2484",
            "fax_number": "763-577-1375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 E Nicollet Blvd Ste 255",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553376768",
            "country_code": "US",
            "telephone_number": "952-892-6222",
            "fax_number": "952-892-6477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2550 University Ave W Ste 189S",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551142001",
            "country_code": "US",
            "telephone_number": "651-332-7474",
            "fax_number": "651-332-7475",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "622 Roosevelt Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563016349",
            "country_code": "US",
            "telephone_number": "952-892-6222",
            "fax_number": "952-892-6477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITTMAN",
        "first_name": "PATHAMAS",
        "middle_name": "CHANTARACHERD",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "MN",
            "license": "S187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ian Mitchell
• Mancel Talcott Mitchell III, M.D.
• Mittal Dermatology PA
• Amit Mittal, MD
• Diliana Stoimenova Mittelsteadt, MD
• Freeman Maral Mjolsness, RPH
• MK Labs LLC
• Gabriel Paul Mlodzik, CNP
• Amy Louise Moe, PA
• Kari A Moe, BCBA

• Orofacial Pain Dentistry in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Orofacial Pain Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.