Devery E Mitchell, MD
Individual provider Active NPI Family Medicine Physician · Sacramento, CA
NPI 1174971196 · NPPES record last updated Aug 12, 2020
Key facts
- NPI
- 1174971196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- A159480 (CA)
- Practice address
- 7601 Hospital Dr Ste 103
Sacramento, CA 95823-5408 - Phone
- (916) 681-1600
- NPI assigned
- May 31, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 36
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southeast Alaska Regional Health Consortium
Winters Healthcare Foundation, Inc.
Practice addresses (Care Compare)
1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611
1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611
1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611
172 E Grant Ave
Winters, CA 95694-1780
Phone 5307954377122
222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411
227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411
3245 Hospital Dr
Juneau, AK 99801-7809
Phone (907) 463-4040
Hospital & facility affiliations
- Silverline Staff Home Health
- Southeast Alaska Regional Health Consortium
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230516002013 | CA | Practitioner - Family Practice | 7416241880 | Reassigns benefits to 1 organization |
| I20250818000677 | TX | Practitioner - Family Practice | 7416241880 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110431 | AK | MD | Family Medicine Physician |
| A159480 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winters Healthcare Foundation, Inc. | Current |
Accepting new patients | |
| Winters Healthcare Foundation, Inc. | Family Medicine | Current |
Accepting new patients |
| Southeast Alaska Regional Health Consortium | Current |
Accepting new patients | |
| Southeast Alaska Regional Health Consortium | Current | Accepting new patients | |
| Southeast Alaska Regional Health Constortium | Current |
Accepting new patients | |
| South East Alaska Regional Health Consortium | Past | Accepting new patients |
Locations
37 Chilkat Ave
Haines, AK 99827
Phone (907) 463-4040
3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000
222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423
17340 Yolo Ave
Esparto, CA 95627
Phone (530) 787-3454
172 E Grant Ave
Winters, CA 95694
Phone (530) 212-1025
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 110431 | AK | |
| Family Medicine Physician | 207Q00000X | A159480 | CA | Yes |
Addresses
Primary practice location
7601 Hospital Dr Ste 103
Sacramento, CA 95823-5408
Mailing address
7601 Hospital Dr Ste 103
Sacramento, CA 95823-5408
Phone (916) 681-1600
Other practice location 1
7601 Hospital Dr Ste 103
Sacramento, CA 95823-5408
Phone (916) 681-1600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1647331 | Medicaid | AK |
NPI Registry JSON
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1174971196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7601 HOSPITAL DR STE 103",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958235408",
"telephone_number": "916-681-1600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7601 HOSPITAL DR STE 103",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958235408",
"telephone_number": "916-681-1600"
}
],
"practiceLocations": [
{
"address_1": "7601 Hospital Dr Ste 103",
"address_purpose": "LOCATION",
"city": "Sacramento",
"state": "CA",
"postal_code": "958235408",
"country_code": "US",
"telephone_number": "916-681-1600",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MITCHELL",
"first_name": "DEVERY",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-31",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AK",
"license": "110431",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A159480",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1647331",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
- Connie Mitchell
- Constance Mitchell
- Damon Mitchell
- David George Mitchell
- Deana Jo Mitchell
- Dianne Ilene Mitchell
- Donna Lynn Mitchell
- Erica Dawn Mitchell
- Hilary Mitchell
- Jeffrey Lynd Mitchell
All providers in Sacramento, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.