PATHAMAS CHANTARACHERD MITTMAN (DDS, MS) – Orofacial Pain Dentistry, NPI 1447972922
Orofacial Pain Dentistry
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
44 DENTIST in MN
Provider Addresses for PATHAMAS CHANTARACHERD MITTMAN (DDS, MS)
622 Roosevelt Rd Ste 120
Saint Cloud, MN 563016349
Phone: (952) 892-6222
Fax: (952) 892-6477
Type: Location
675 E Nicollet Blvd Ste 255
Burnsville, MN 553376768
Phone: (952) 892-6222
Fax: (952) 892-6477
Type: Location
2550 University Ave W Ste 189S
Saint Paul, MN 551142001
Phone: (651) 332-7474
Fax: (651) 332-7475
Type: Location
3475 PLYMOUTH BLVD STE 200
PLYMOUTH, MN 554471539
Phone: (763) 577-2484
Fax: (763) 577-1375
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-12-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20221223000855 | I | Dentist | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 42 | 25 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 33 | 33 | $0 |
Insurance plans in this area (ZIP 56301)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Pain Management, Oral Surgery | MN | |
| Physical Therapist In Private Practice | MN | |
| Dentist, Pain Management | MN | |
| Oral Surgery | MN | |
| Maxillofacial Surgery, Oral Surgery | MN | |
| Dentist, Pain Management | MN | |
| - | MN |
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