NPIMap

Individual provider Active NPI

Maxim Mitchell, MD

  • Family Medicine Physician
  • Dunkirk, NY
National Provider Identifier
1194175968
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
299484 Issued in NY
Practice address
3898 Vineyard Dr
Dunkirk, NY 14048
Phone
(716) 646-5500
NPI assigned
Jun 13, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 299484 NY Primary
Family Medicine Physician 207Q00000X RL14088 ND

Addresses

Primary practice location

3898 Vineyard Dr
Dunkirk, NY 14048

Mailing address

3750 Heatherwood Dr Apt B10
Hamburg, NY 14075-2271
Phone (701) 780-6824

Other practice location 1

725 Hamline St
Grand Forks, ND 58203-2819
Phone (701) 780-6824

Other practice location 2

3898 Vineyard Dr
Dunkirk, NY 14048
Phone (716) 646-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20190905002378 NY Practitioner - Family Practice 8820382666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
General Physician PCGroup PAC ID 9537213079, 488 clinicians

Practice addresses (Care Compare)

18 Limestone Dr
Suite 5
Williamsville, NY 14221-8602
Phone (716) 632-1400

3898 Vineyard Dr
Dunkirk, NY 14048-3559
Phone (716) 710-8266

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RL14088NDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
General Physician, PC CurrentSince Sep 1, 2019 Accepting new patients
Brooks-TLC Hospital System, Inc. CurrentSince Jul 21, 2021 Accepting new patients
Brooks - TLC Hospital System, Inc. CurrentSince Jul 21, 2021 Accepting new patients

Locations

529 Central Ave
Dunkirk, NY 14048
Phone (716) 338-9797

3898 Vineyard Dr
Dunkirk, NY 14048
Phone (716) 363-1515

18 Limestone Dr
Ste 5
Williamsville, NY 14221
Phone (716) 626-7415

Interoperability endpoints

  • Direct secure messaging: mmitchell@gppc.medentdirect.com

Organizations & group practices 3

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 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1194175968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 HEATHERWOOD DR APT B10",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140752271",
            "telephone_number": "701-780-6824",
            "fax_number": "701-780-4391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3898 VINEYARD DR",
            "city": "DUNKIRK",
            "state": "NY",
            "postal_code": "14048",
            "telephone_number": "716-646-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "725 Hamline St",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582032819",
            "country_code": "US",
            "telephone_number": "701-780-6824",
            "fax_number": "701-780-4391",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3898 Vineyard Dr",
            "address_purpose": "LOCATION",
            "city": "Dunkirk",
            "state": "NY",
            "postal_code": "14048",
            "country_code": "US",
            "telephone_number": "716-646-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "MAXIM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-13",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "299484",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "RL14088",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunkirk, NY

Sources for this page

Verify at the official NPI Registry.