NPIMap

Individual provider Active NPI

Kenneth Dernell Mitchell, DPM

  • Podiatrist
  • Southfield, MI
National Provider Identifier
1144390873
Registry record updated Oct 22, 2013
On this page

OIG exclusion record

The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:

  • Section 1128a(1) exclusion effective Dec 19, 2024.

Matched on NPI only. Confirm current status with the OIG exclusions search before relying on it.

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
5901001869 Issued in MI
Practice address
23999 Northwestern Hwy
Suite 220a
Southfield, MI 48075-2578
Phone
(248) 996-6465
Fax
(248) 996-6469
NPI assigned
Nov 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 5901001869 MI Primary

Addresses

Primary practice location

23999 Northwestern Hwy
Suite 220a
Southfield, MI 48075-2578

Mailing address

23999 Northwestern Hwy
Suite 220a
Southfield, MI 48075-2578
Phone (248) 996-6465

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
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Practice roles

OrganizationSpecialtyStatusNew patients
Home Visiting Group,Inc Past Accepting new patients
House Calls Physicians PLLC PastSince May 19, 2011 Accepting new patients
Quality Foot & Ankle Clinic PastSince Nov 8, 2004 Accepting new patients
Mitchell Healthcare Associates Podiatrist PastSince Jan 1, 1990 Accepting new patients
Greater Detroit Community Care PastSince Nov 13, 2003 Accepting new patients
People Helping People of Detroit PastSince Dec 3, 2023 Accepting new patients
Home Visiting Doctors, PLLC Past Accepting new patients
Comprehensive Health Access Resource of Michigan Past Accepting new patients

Organizations & group practices 8

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": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382400000000",
    "number": "1144390873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23999 NORTHWESTERN HWY",
            "address_2": "SUITE 220A",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752578",
            "telephone_number": "248-996-6465",
            "fax_number": "248-996-6469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23999 NORTHWESTERN HWY",
            "address_2": "SUITE 220A",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752578",
            "telephone_number": "248-996-6465",
            "fax_number": "248-996-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KENNETH",
        "middle_name": "DERNELL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "5901001869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.