Alexander Dematteis IV, ED.D.

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1654 Bryan Rd
O Fallon, MO 63368-4897

Phone

(636) 344-0433

NPI assigned

May 29, 2024

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1477393163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2682 VICTRON DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631293148",
            "telephone_number": "314-657-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1654 BRYAN RD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633684897",
            "telephone_number": "636-344-0433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2682 Victron Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631293148",
            "country_code": "US",
            "telephone_number": "314-657-7068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMATTEIS",
        "first_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "ED.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katherine Michelle Derickson, PHARM.D.

• Counselor in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.