Mario Mitkov, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2019-00501 Issued in NC

Practice address

3107 Brassfield Rd Ste 300
Greensboro, NC 27410-2074

Phone

(336) 545-8133

NPI assigned

Apr 30, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, NC, VA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Dermatology

Education

Mayo Medical School, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Estero Dermatology and Skin Surgery Center, LLCGroup PAC ID 6103822176, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• devoted network organization-92131eb0-09f2-4173-a140-cf7b381f0cf1
• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• Direct secure messaging: mmitkov@directaddress.net
• Direct secure messaging: mario.mitkov@qdp.emadirect.md

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.

• Estero Dermatology & Skin Surgery Center, LLC

  • Dermatology Physician
  • Estero, FL
  • NPI 1568481901
  Medicare reassignment Care Compare group NPD
• Skin Surgery Center PA

  • Dermatology Physician
  • Winston Salem, NC
  • NPI 1649237082

  VA

  Medicare reassignment NPD
• Skin Surgery Center PA

  • MOHS-Micrographic Surgery Physician
  • Mount Pleasant, SC
  • NPI 1851810279
  NPD
• Associates in Medicine & Surgery LLC

  • Foot & Ankle Surgery Podiatrist
  • Fort Myers, FL
  • NPI 1386884385
  NPD (past)

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

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1003226051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 PROFESSIONAL PARK DR STE 150",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031307",
            "telephone_number": "336-724-2434",
            "fax_number": "336-607-8061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3107 BRASSFIELD RD STE 300",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274102074",
            "telephone_number": "336-545-8133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "312 Fairy Street Ext Ste 201",
            "address_purpose": "LOCATION",
            "city": "Martinsville",
            "state": "VA",
            "postal_code": "241121912",
            "country_code": "US",
            "telephone_number": "276-632-6496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1450 Professional Park Dr Ste 150",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031307",
            "country_code": "US",
            "telephone_number": "336-724-2434",
            "fax_number": "336-607-8061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITKOV",
        "first_name": "MARIO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-30",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101266560",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME124757",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NC",
            "license": "2019-00501",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "VA",
            "license": "0101266560",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2019-00501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Elaine Mitchell, MD
• Sheretta Shree Mitchell, M.S.,LCAS-A
• Susie Law Mitchell, CRNA
• Torkwase' K Mitchell
• Robert Andrew Mitchum, PHD
• Allison Mize
• Jennifer K Mize, M.S.,CCC-SLP
• William Randolph Mize Jr., RPH
• Renee Mizerek, RBT
• Mizpah Healthcare, Inc.

• Dermatology Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; 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.
• 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.