Active NPI
Matthew J. Mitsch, MD
- Specialist
- Virginia BCH, VA
National Provider Identifier
1083624084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 0101052465
- Practice address
- Suite 6
1821 Old Donation Parkway
Virginia BCH, VA 23454-3033 - Phone
- (757) 496-4864
- Fax
- (757) 496-4942
- NPI assigned
- Aug 9, 2006
- Last updated
- Jul 30, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 0101052465 | VA | Primary |
Addresses
Primary practice location
Suite 6
1821 Old Donation Parkway
Virginia BCH, VA 23454-3033
Mailing address
Suite 6
1821 Old Donation Parkway
Virginia BCH, VA 23454-3033
Phone (757) 496-4864
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 333299 | Other | VA | MAMSI |
| 54-1816313 | Other | VA | VA. HEALTH NETWORK |
| 44740849 | Other | VA | MULTI-PLAN PPO |
| 54-1816313 | Other | VA | AARP |
| 0499149 | Other | VA | GHI |
| 142942XX | Other | VA | PREFERRED CARE |
| 54-1816313 | Other | VA | TRICARE |
| 54-1816313 | Other | VA | MAILHANDLERS |
| 600212807 | Other | VA | CIGNA |
| 54-1816313 | Other | VA | AETNA |
| 54-1816313 | Other | VA | UNITED HEALTHCARE |
| 6900925 | Medicaid | VA | |
| 380172 | Other | VA | ANTHEM |
| 54-1816313 | Other | VA | PRIORITY HEALTHCARE INC. |
| 3078121 | Other | VA | CIGNA PPO |
| 61240 | Other | VA | OPTIMA |
| 843259 | Other | VA | FIRST HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
Organizations & group practices 1
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.
-
dba The Face Institute
- Specialist
- Virginia Beach, VA
- NPI 1154535623
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217376000000",
"number": "1083624084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "SUITE 6",
"address_2": "1821 OLD DONATION PARKWAY",
"city": "VIRGINIA BCH",
"state": "VA",
"postal_code": "234543033",
"telephone_number": "757-496-4864",
"fax_number": "757-496-4942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "SUITE 6",
"address_2": "1821 OLD DONATION PARKWAY",
"city": "VIRGINIA BCH",
"state": "VA",
"postal_code": "234543033",
"telephone_number": "757-496-4864",
"fax_number": "757-496-4942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITSCH",
"first_name": "MATTHEW",
"middle_name": "J.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2008-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "VA",
"license": "0101052465",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "333299",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA. HEALTH NETWORK",
"identifier": "54-1816313",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTI-PLAN PPO",
"identifier": "44740849",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AARP",
"identifier": "54-1816313",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "0499149",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "142942XX",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "54-1816313",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAILHANDLERS",
"identifier": "54-1816313",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "600212807",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "54-1816313",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "54-1816313",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6900925",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "380172",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTHCARE INC.",
"identifier": "54-1816313",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PPO",
"identifier": "3078121",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA",
"identifier": "61240",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "843259",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Virginia BCH, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.