Mitchell Jackson Moffitt, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M-10017 Issued in ID

Practice address

775 Pole Line Rd W
Suite 111
Twin Falls, ID 83301-5814

Phone

(208) 814-8000

Fax

(208) 733-9402

NPI assigned

Oct 16, 2006

Last updated

Jan 7, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• St Luke's Clinic LLC

  dba St Lukes Clinic - Magic Valley/Jerome

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1790718229

  Pediatrics

  Medicare reassignment NPD
• Physician Center , a Professional Company

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1508807926
  Authorized official Same address or phone
• Physician Center a Professional Company Mid Level

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1245414028
  Authorized official Same address or phone
• St Luke's Magic Valley Regional Medical Center LTD

  dba St Lukes Retail Pharmacy Twin Falls

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420588800000",
    "number": "1093895229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 111",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8000",
            "fax_number": "208-733-9402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFITT",
        "first_name": "MITCHELL",
        "middle_name": "JACKSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2015-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-10017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807839500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cortney R Mitchell, AUD,BS,AA
• Rosemary L Mitchell, LMSW
• Lisa A Mitton, LCSW
• Maverick Mitton, FNP-C
• M Andrew Mix, RPT
• Stanley Mogelson, M.D.
• Rebecca Ann Molina, FNP
• Chad Robert Momberger, CRNA
• Andrew Nolan Monson, D.O.
• Emily Nicole Montague, CNP

• Pediatrics Physician in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.