Individual provider Active NPI

Mitulkumar P Patel, M.D.

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1093701674
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10855 Issued in NV
Practice address
4880 Wynn Rd
Las Vegas, NV 89103-5406
Phone
(702) 871-5005
Fax
(702) 671-6883
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 10855 NV Primary
Internal Medicine Physician 207R00000X G74858 CA

Addresses

Primary practice location

4880 Wynn Rd
Las Vegas, NV 89103-5406

Mailing address

PO Box 1737
Las Vegas, NV 89125-1737
Phone (702) 671-6809

Other identifiers 3

IdentifierTypeStateIssuer
100507193MedicaidNV
CS12512OtherNVPHARMACY/CONTROLLED SUBSTANCE CERTIFICATE
10855OtherNVMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040713000292 NV Practitioner - Internal Medicine 2961480264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care PAGroup PAC ID 9739260019, 545 clinicians

Practice addresses (Care Compare)

5850 S Polaris Rd
Suite 100
Las Vegas, NV 89118-3185
Phone (702) 739-9957

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue20

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. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G74858CAMDInternal Medicine Physician
10855NVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care PA CurrentSince Oct 6, 2019 Accepting new patients
Innovative Wound Management, LLC CurrentSince Nov 1, 2024 Accepting new patients
Intermountain Medical Holdings Nevada Inc Internal Medicine Past Accepting new patients

Locations

149 N Gibson Rd
Ste H
Henderson, NV 89014
Phone (702) 558-6275

5850 Polaris Ave
Ste 100
Las Vegas, NV 89118
Phone (702) 739-9957

8551 W Lake Mead Blvd
Ste 200
Las Vegas, NV 89128
Phone (702) 869-8720

255 Glendale Ave
Ste 12
Sparks, NV 89431
Phone (775) 356-8181

Organizations & group practices 3

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 2

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1093701674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1737",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891251737",
            "telephone_number": "702-671-6809",
            "fax_number": "702-671-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4880 WYNN RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891035406",
            "telephone_number": "702-871-5005",
            "fax_number": "702-671-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "MITULKUMAR",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "10855",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G74858",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100507193",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY/CONTROLLED SUBSTANCE CERTIFICATE",
            "identifier": "CS12512",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "10855",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.