Active NPI
John Mattison Davis, M.D.
- Psychiatry Physician
- Saint Paul, MN
National Provider Identifier
1700857620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 0101264206
- Practice address
- 680 Stewart Ave
Saint Paul, MN 55102-4117 - Phone
- (800) 257-7800
- NPI assigned
- Jan 30, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | 0101264206 | VA | |
| Psychiatry Physician | 2084P0800X | 0101264206 | VA | Primary |
Addresses
Primary practice location
680 Stewart Ave
Saint Paul, MN 55102-4117
Mailing address
680 Stewart Ave
Saint Paul, MN 55102-4117
Phone (800) 257-7800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100127820 | Medicaid | KY | |
| P00872494 | Other | KY | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101264206 | VA | MD | Addiction Medicine (Psychiatry & Neurology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781481600000",
"number": "1700857620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 STEWART AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551024117",
"telephone_number": "800-257-7800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 STEWART AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551024117",
"telephone_number": "800-257-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JOHN",
"middle_name": "MATTISON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2026-06-15",
"certification_date": "2026-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "VA",
"license": "0101264206",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101264206",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100127820",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00872494",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.