Individual provider Active NPI

Jeanette Kamell Mitchell, MD

  • Dermatology Physician
  • Thousand Oaks, CA
National Provider Identifier
1154567410
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A106113 Issued in CA
Practice address
55 Rolling Oaks Dr Ste 200
Thousand Oaks, CA 91361-1010
Phone
(805) 497-7529
Fax
(805) 494-3486
NPI assigned
Dec 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A106113 CA Primary

Addresses

Primary practice location

55 Rolling Oaks Dr Ste 200
Thousand Oaks, CA 91361-1010

Mailing address

2285 Corporate Cir
Ste 200
Henderson, NV 89074-7759
Phone (702) 360-2763

Other names 1

  • Jeanette Marie Kamell Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20110908002288 CA Practitioner - Dermatology 6305016957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of California, Irvine, California College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
J Robert West MD IncGroup PAC ID 8729990973, 141 clinicians

Practice addresses (Care Compare)

55 Rolling Oaks Dr
Suite 200
Thousand Oaks, CA 91361-1010
Phone (805) 497-7539

Merit-based Incentive Payment System (MIPS)

Final score
85.17 of 100Reported as group
Quality
74.51
Promoting interoperability
92
Improvement activities
40
Cost
82.72

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision195
Removal of skin lesions85
Removal of skin cancer1152
Skin biopsy129

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A106113CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
J Robert West, M.D., Inc Dermatology CurrentSince Oct 1, 2020 Accepting new patients
J. Robert West, M.D., Inc Dermatology Past Accepting new patients

Locations

400 Newport Center Dr
Ste 702
Newport Beach, CA 92660
Phone (949) 644-0101

55 Rolling Oaks Dr
Ste 200
Thousand Oaks, CA 91361
Phone (805) 497-7529

2285 Corporate Cir
Ste 200
Henderson, NV 89074
Phone (702) 360-2763

Interoperability endpoints

  • Direct secure messaging: jkm104pcs@m743.primeclinicalsystems.direct-ci.com

Organizations & group practices 2

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": "1229385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1154567410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 CORPORATE CIR",
            "address_2": "STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747759",
            "telephone_number": "702-360-2763",
            "fax_number": "949-783-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 ROLLING OAKS DR STE 200",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611010",
            "telephone_number": "805-497-7529",
            "fax_number": "805-494-3486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JEANETTE",
        "middle_name": "KAMELL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-16",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A106113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANETTE",
            "last_name": "KAMELL",
            "middle_name": "MARIE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Thousand Oaks, CA

Sources for this page

Verify at the official NPI Registry.