Active NPI
Richard L Mittan, PA-C
- Physician Assistant
- Odessa, TX
National Provider Identifier
1215446919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 4040 Medical Park Dr
Odessa, TX 79765-2233 - Phone
- (432) 333-6603
- Fax
- (432) 333-8014
- NPI assigned
- Sep 25, 2017
- Last updated
- Jun 17, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | NU | Primary |
Addresses
Primary practice location
4040 Medical Park Dr
Odessa, TX 79765-2233
Mailing address
PO Box 734240
Chicago, IL 60673-4240
Phone (615) 810-8728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Wake Forest University School of Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4040 Medical Park Dr
Odessa, TX 79765-2233
Phone (432) 217-0344
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chappell Rosso Dermatology PA | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Procedural Dermatology Physician
- Odessa, TX
- NPI 1962625533
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750118400000",
"number": "1215446919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 734240",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606734240",
"telephone_number": "615-810-8728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4040 MEDICAL PARK DR",
"city": "ODESSA",
"state": "TX",
"postal_code": "797652233",
"telephone_number": "432-333-6603",
"fax_number": "432-333-8014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTAN",
"first_name": "RICHARD",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-25",
"last_updated": "2025-06-17",
"certification_date": "2025-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; 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.