Rolfe C McCoy, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

014421 Issued in MO

Practice address

850 Fairway Chadwick Plaza
Chillicothe, MO 64601

Phone

(660) 646-3802

Fax

(660) 646-3887

NPI assigned

Sep 27, 2006

Last updated

May 10, 2011By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• McCoy Samples Mattingly Dental Clinic

  • General Practice Dentistry
  • Chillicothe, MO
  • NPI 1457551483
  Authorized official Same address or phone

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1811088016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 FAIRWAY CHADWICK PLAZA",
            "city": "CHILLICOTHE",
            "state": "MO",
            "postal_code": "64601",
            "telephone_number": "660-646-3802",
            "fax_number": "660-646-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 FAIRWAY CHADWICK PLAZA",
            "city": "CHILLICOTHE",
            "state": "MO",
            "postal_code": "64601",
            "telephone_number": "660-646-3802",
            "fax_number": "660-646-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOY",
        "first_name": "ROLFE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "014421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402130603",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "12140021",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "846891",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Mason, RN
• Mary Ann Mathew, P.T.
• David A Mattingly, D.D.S.
• Emily A Mattingly, DDS
• McCoy Samples Mattingly Dental Clinic
• Barbara D McCullough, FNP-C
• Marie Elizabeth McKinley, LPC
• Erin R McMains, LPC, EDS, MS
• Allison McQuinn, M.S. CCC-SLP
• Medicine Shoppe

• Dentist in Chillicothe, MO
• Providers in Chillicothe, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.