Individual provider Active NPI

Kristina Orey Mitchell, M.D.

  • Pediatrics Physician
  • Tyler, TX
National Provider Identifier
1104121409
Registry record updated Aug 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
N7843 Issued in TX
Practice address
1000 E 5TH St Ste 100
Tyler, TX 75701-3307
Phone
(903) 596-3862
Fax
(903) 590-5005
NPI assigned
Jan 18, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X N7843 TX Primary

Addresses

Primary practice location

1000 E 5TH St Ste 100
Tyler, TX 75701-3307

Mailing address

1000 E 5TH St Ste 100
Tyler, TX 75701-3307
Phone (903) 596-3862

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20110803000320 TX Practitioner - Pediatric Medicine 8820267164 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Etmc Physician Group Inc. CurrentSince Mar 1, 2018 Accepting new patients
Starks Medical Past Accepting new patients

Locations

18118 FM 344 W
Flint, TX 75762
Phone (903) 825-3292

1000 E 5th St
Ste 400
Tyler, TX 75701
Phone (903) 593-1749

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

1000 E 5th St
Ste 100
Tyler, TX 75701
Phone (903) 590-5000

Interoperability endpoints

  • Direct secure messaging: kmitchell355036@ahs.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344297600000",
    "number": "1104121409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E 5TH ST STE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757013307",
            "telephone_number": "903-596-3862",
            "fax_number": "903-590-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E 5TH ST STE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757013307",
            "telephone_number": "903-596-3862",
            "fax_number": "903-590-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KRISTINA",
        "middle_name": "OREY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-18",
        "last_updated": "2012-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "N7843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.