Individual provider Active NPI

Michael Mitchell, DO

  • Pediatrics Physician
  • Columbia, SC
National Provider Identifier
1225440910
Registry record updated May 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
LL36665 Issued in SC
Practice address
14 Medical Park Ste 400
Pediatric Clinic
Columbia, SC 29203
Phone
(803) 434-6155
Fax
(803) 434-6979
NPI assigned
May 29, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LL36665 SC Primary

Addresses

Primary practice location

14 Medical Park Ste 400
Pediatric Clinic
Columbia, SC 29203

Mailing address

14 Medical Park Ste 400
Pediatric Clinic
Columbia, SC 29203
Phone (803) 434-6155

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200731002929 TX Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 6608162672 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Hematology/Oncology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dell Childrens Medical GroupGroup PAC ID 8224092978, 117 clinicians

Practice addresses (Care Compare)

1301 Barbara Jordan Blvd
Suite 401
Austin, TX 78723-3078
Phone (512) 628-1900

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL36665SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dell Children'S Medical Group CurrentSince Jul 27, 2020 Accepting new patients
Dell Children'S Medical Group Pediatrics CurrentSince Jul 27, 2020 Accepting new patients
Ascension Seton Past Accepting new patients

Locations

1301 Barbara Jordan Blvd
Ste 200
Austin, TX 78723
Phone (512) 628-1800

1301 Barbara Jordan Blvd
Ste 401
Austin, TX 78723
Phone (512) 628-1810

Interoperability endpoints

  • Direct secure messaging: michael.mitchell.1@8363.direct.athenahealth.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.

NPI Registry JSON

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401321600000",
    "number": "1225440910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MEDICAL PARK STE 400",
            "address_2": "PEDIATRIC CLINIC",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-6155",
            "fax_number": "803-434-6979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MEDICAL PARK STE 400",
            "address_2": "PEDIATRIC CLINIC",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-6155",
            "fax_number": "803-434-6979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-29",
        "last_updated": "2014-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL36665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.