NPIMap

Individual provider Active NPI

Mitchell L Wiatrak, MD

  • Urology Physician
  • Glasgow, KY
National Provider Identifier
1114914900
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
42456 Issued in KY
Practice address
310 N L Rogers Wells Blvd
Glasgow, KY 42141-1300
Phone
(270) 659-5965
Fax
(270) 659-5856
NPI assigned
Oct 5, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 42456 KY Primary

Addresses

Primary practice location

310 N L Rogers Wells Blvd
Glasgow, KY 42141-1300

Mailing address

310 N L Rogers Wells Blvd
Glasgow, KY 42141-1300
Phone (270) 659-5965

Other identifiers 1

IdentifierTypeStateIssuer
7100117860MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Mitchell.Wiatrak@tjrh.cernerdirect.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090605000108 KY Practitioner - Urology 9931114295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Michigan Medical School, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
T J Samson Community HospitalGroup PAC ID 0648182600, 197 clinicians

Practice addresses (Care Compare)

310 N L Rogers Wells Blvd
Glasgow, KY 42141-1300
Phone (270) 651-1111

Hospital & facility affiliations

  • T J Samson Community Hospital Hospital, Glasgow, KY, CCN 180017
  • TJ Health Columbia Hospital, Columbia, KY, CCN 180149
  • The Medical Center (Bowling Green) Hospital, Bowling Green, KY, CCN 180013

Merit-based Incentive Payment System (MIPS)

Final score
86.3 of 100Reported as group
Quality
74.59
Promoting interoperability
100
Improvement activities
40
Cost
68.87

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42456KYMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
T J Samson Community Hospital Current Accepting new patients
T J Samson Community Hospital Current Accepting new patients
T J Samson Community Hospital CurrentSince Aug 6, 2018 Accepting new patients
T J Samson Community Hospital CurrentSince Aug 6, 2018 Accepting new patients
T J Samson Community Hospital Past Accepting new patients
Urology Specialists S.C. PastSince Jan 1, 2005 Accepting new patients

Locations

310 N L Rogers Wells Blvd
Glasgow, KY 42141
Phone (270) 651-1111

1301 N Race St
Glasgow, KY 42141
Phone (270) 651-4141

Interoperability endpoints

  • Direct secure messaging: mitchell.wiatrak@tjrh.cernerdirect.com

Organizations & group practices 6

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 4

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": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1114914900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N L ROGERS WELLS BLVD",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421411300",
            "telephone_number": "270-659-5965",
            "fax_number": "270-659-5856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 N L ROGERS WELLS BLVD",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421411300",
            "telephone_number": "270-659-5965",
            "fax_number": "270-659-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIATRAK",
        "first_name": "MITCHELL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "KY",
            "license": "42456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100117860",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mitchell.Wiatrak@tjrh.cernerdirect.com",
            "affiliation": "N",
            "address_1": "310 N L Rogers Wells Blvd",
            "city": "Glasgow",
            "state": "KY",
            "country_code": "US",
            "postal_code": "421411300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Glasgow, KY

Sources for this page

Verify at the official NPI Registry.