NPIMap

Individual provider Active NPI

Mitchell Newton Nettleton, PA-C

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1033754734
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10317 Issued in GA
Practice address
1364 Clifton Rd NE
Atlanta, GA 30322-9822
Phone
(812) 325-3735
NPI assigned
Nov 18, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10002860A IN
Physician Assistant 363A00000X 10317 GA Primary

Addresses

Primary practice location

1364 Clifton Rd NE
Atlanta, GA 30322-9822

Mailing address

871 3Rd St NW Apt 1611
Atlanta, GA 30318-6067
Phone (812) 325-3735

Other practice location 1

13100 E 136th St Ste 3600
Fishers, IN 46037-9822
Phone (317) 962-3700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mnettleton@direct.iuhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191211000176 IN Practitioner - Physician Assistant 4486087152 Reassigns benefits to 2 organizations
I20210618000206 GA Practitioner - Physician Assistant 4486087152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Emory Clinic Inc CurrentSince Jun 1, 2021 Accepting new patients
Indiana University Health Care Associates, Inc. CurrentSince Feb 12, 2021 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

5208 Reliable Pkwy
Chicago, IL 60686

13100 E 136th St
Ste 3600
Fishers, IN 46037
Phone (317) 678-3777

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

Interoperability endpoints

  • Direct secure messaging: mnettleton@direct.iuhealth.org
  • Direct secure messaging: mnettleton48710@direct.emory.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1033754734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "871 3RD ST NW APT 1611",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303186067",
            "telephone_number": "812-325-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303229822",
            "telephone_number": "812-325-3735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13100 E 136th St Ste 3600",
            "address_purpose": "LOCATION",
            "city": "Fishers",
            "state": "IN",
            "postal_code": "460379822",
            "country_code": "US",
            "telephone_number": "317-962-3700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NETTLETON",
        "first_name": "MITCHELL",
        "middle_name": "NEWTON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-18",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002860A",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mnettleton@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "13100 E 136th St Ste 3600",
            "city": "Fishers",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460379822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.