Individual provider Active NPI

Daniel Mattison

  • Occupational Therapist
  • Anthem, AZ
National Provider Identifier
1780438812
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OTH-008223 Issued in AZ
Practice address
4516 W Fortune Dr
Anthem, AZ 85086-1401
Phone
(480) 223-0885
NPI assigned
Apr 15, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OTH-008223 AZ Primary

Addresses

Primary practice location

4516 W Fortune Dr
Anthem, AZ 85086-1401

Mailing address

4516 W Fortune Dr
Anthem, AZ 85086-1401
Phone (480) 223-0885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240523000221 AZ Practitioner - Occupational Therapist in Private Practice 5799127650 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

110 Horizon Dr
Suite 310
Raleigh, NC 27615-4926

4516 W Fortune Dr
Anthem, AZ 85086-1401

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc Occupational Therapist CurrentSince Apr 29, 2024 Accepting new patients
Empowerme Rehabilitation, LLC Occupational Therapist CurrentSince May 14, 2024 Accepting new patients
Legacy Healthcare Services Inc Occupational Therapist CurrentSince Apr 29, 2024 Accepting new patients
Empowerme Rehabilitation, LLC Occupational Therapist CurrentSince May 14, 2024 Accepting new patients

Locations

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

110 Horizon Dr
#310
Raleigh, NC 27615

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1780438812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 W FORTUNE DR",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850861401",
            "telephone_number": "480-223-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 W FORTUNE DR",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850861401",
            "telephone_number": "480-223-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTISON",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AZ",
            "license": "OTH-008223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anthem, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.