Individual provider Active NPI

Brandon Lamar Mitchell, PAC

  • Medical Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1194092973
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9106322 Issued in FL
Practice address
820 Prudential Dr Ste 304
Jacksonville, FL 32207-8205
Phone
(904) 202-3860
Fax
(904) 202-3846
NPI assigned
Nov 22, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9106322 FL Primary

Addresses

Primary practice location

820 Prudential Dr Ste 304
Jacksonville, FL 32207-8205

Mailing address

PO Box 746638
Atlanta, GA 30374-6638
Phone (904) 202-2092

Other practice location 1

1926 10th Ave N Ste 105
Lake Worth, FL 33461-3300
Phone (615) 345-5400

Other practice location 2

1200 Riverplace Blvd
Suite 620
Jacksonville, FL 32207-9046
Phone (904) 396-6620

Other identifiers 1

IdentifierTypeStateIssuer
006445300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120208000960 FL Practitioner - Physician Assistant 4880851419 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Primary Care IncGroup PAC ID 0648177733, 459 clinicians

Practice addresses (Care Compare)

11401 Old Saint Augustine Rd
Jacksonville, FL 32258-1402
Phone (904) 260-1818

13241 Bartram Park Blvd
Unit 2105
Jacksonville, FL 32258-5224
Phone (904) 292-4111

13720 Old Saint Augustine Rd
Suite 1
Jacksonville, FL 32258-7415
Phone (904) 288-5550

14534 Old Saint Augustine Rd
Jacksonville, FL 32258-2617

14540 Old Saint Augustine Rd
Suite 2201
Jacksonville, FL 32258-7418
Phone (904) 880-9696

1660 Prudential Dr
Suite 201
Jacksonville, FL 32207-8185
Phone (904) 202-4222

1660 Prudential Dr
Suite 310
Jacksonville, FL 32207-8197
Phone (904) 396-8656

1660 Prudential Dr
Suite 400
Jacksonville, FL 32207-8188
Phone (904) 396-0000

3563 Phillips Hwy 101
Jacksonville, FL 32207

5304 Bartram Commons Dr
Jacksonville, FL 32258-6104
Phone (904) 376-3970

820 Prudential Dr
Suite 304
Jacksonville, FL 32207-8205
Phone (904) 202-3860

820 Prudential Dr
Suite 515
Jacksonville, FL 32207-8207
Phone (904) 396-4886

836 Prudential Dr
Suite 105a
Jacksonville, FL 32207-8300
Phone (904) 202-4325

Hospital & facility affiliations

  • Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088

Merit-based Incentive Payment System (MIPS)

Final score
95.44 of 100Reported as apm
Quality
84.21
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Primary Care Inc CurrentSince Apr 19, 2021 Accepting new patients
Baptist Primary Care Inc CurrentSince Apr 19, 2021 Accepting new patients
Baptist Primary Care Inc Past Accepting new patients

Locations

820 Prudential Dr
Ste 304
Jacksonville, FL 32207
Phone (904) 202-3860

836 Prudential Dr
Ste 1207
Jacksonville, FL 32207
Phone (904) 396-8656

Organizations & group practices 4

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 1

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": "1321920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1194092973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 PRUDENTIAL DR STE 304",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078205",
            "telephone_number": "904-202-3860",
            "fax_number": "904-202-3846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1926 10th Ave N Ste 105",
            "address_purpose": "LOCATION",
            "city": "Lake Worth",
            "state": "FL",
            "postal_code": "334613300",
            "country_code": "US",
            "telephone_number": "615-345-5400",
            "fax_number": "888-468-6511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Riverplace Blvd",
            "address_2": "Suite 620",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322079046",
            "country_code": "US",
            "telephone_number": "904-396-6620",
            "fax_number": "904-396-6528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "BRANDON",
        "middle_name": "LAMAR",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-22",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006445300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.