Kristofer J. Mitchell, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036120394 Issued in IL

Practice address

800 N 1St St
Springfield, IL 62702-3719

Phone

(217) 528-7541

NPI assigned

May 9, 2007

Last updated

Jan 31, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

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

Specialty

Critical Care (Intensivists)Also: General Surgery

Education

Southern Illinois University School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians

Urgent Specialty Associates of Utah PLLCGroup PAC ID 3476904442, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mark's Hospital Hospital, Salt Lake City, UT, CCN 460047
• Lone Peak Hospital Hospital, Draper, UT, CCN 460060
• Northeastern Nevada Regional Hospital Hospital, Elko, NV, CCN 290008
• Memorial Hospital Sweetwater County Hospital, Rock Springs, WY, CCN 531318
• Lakeview Hospital Hospital, Bountiful, UT, CCN 460042

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Intensive Care Consortium Inc

  • Specialist
  • Aventura, FL
  • NPI 1629019062

  UT

  Medicare reassignment Care Compare group NPD
• Urgent Specialty Associates of Utah PLLC

  • Surgical Critical Care Physician
  • Salt Lake City, UT
  • NPI 1992587778
  Medicare reassignment Care Compare group NPD
• Physician Group of Utah Inc

  • Specialist
  • South Jordan, UT
  • NPI 1477676930
  Medicare reassignment NPD

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

• Hospital Corporation of Utah

  dba Lakeview Hospital

  • General Acute Care Hospital
  • Bountiful, UT
  • NPI 1528010451
  Care Compare affiliation
• Lone Peak Hospital, Inc.

  dba Lone Peak Hospital

  • General Acute Care Hospital
  • Draper, UT
  • NPI 1770821571
  Care Compare affiliation
• Memorial Hospital of Sweetwater County

  dba County of Sweetwater

  • Critical Access Hospital
  • Rock Springs, WY
  • NPI 1558361949
  Care Compare affiliation
• Northern Utah Healthcare Corporation

  dba St. Mark's Hospital

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1164469243
  Care Compare affiliation
• PHC-Elko Inc

  dba Northeastern Nevada Regional Hospital

  • Rural Acute Care Hospital
  • Elko, NV
  • NPI 1770674350
  Care Compare affiliation

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1205040664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627023719",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KRISTOFER",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036120394",
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "IL",
            "license": "036120394",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "IL",
            "license": "036120394",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "R01662",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036120394",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmitchell47787@epicmtn.hcadirect.net",
            "affiliation": "N",
            "address_1": "800 N 1st St",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627023719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica N Mistretta, DO
• Brittany R. Mitchell, LMT
• Cheryl Mitchell
• James Allen Mitchell, CRNA
• Jessica Christine Mitchell, PA-C
• Nicole Shontrease Mitchell, CRNA
• Robin Mitchell, LMFT
• Khaled Mitwally, MD
• Mizani Therapeutic Services, LLC
• Audrianna Mizeur

• Surgery Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.