Individual provider Active NPI

Sally Ann Mitchell, CAA

  • Anesthesiologist Assistant
  • Joplin, MO
National Provider Identifier
1265517601
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
2024023954 Issued in MO
Practice address
1102 W 32ND St
Joplin, MO 64804-3503
Phone
(417) 347-5222
NPI assigned
Oct 26, 2006
Last updated
Sep 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 003351 GA
Anesthesiologist Assistant 367H00000X 75000008A IN
Anesthesiologist Assistant 367H00000X 2024023954 MO Primary

Addresses

Primary practice location

1102 W 32ND St
Joplin, MO 64804-3503

Mailing address

Fpho Managed Care
1102 West 32ND Street
Joplin, MO 64804

Other practice location 1

705 Riley Hospital Dr
Indianapolis, IN 46202-5109
Phone (317) 274-0275

Other practice location 2

550 Peachtree St
Atlanta, GA 30308
Phone (404) 778-4852

Other identifiers 1

IdentifierTypeStateIssuer
100000298BMedicaidDC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smitchell@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20161219002145 IN Practitioner - Anesthesiology Assistant 5092980847 Reassigns benefits to 1 organization
I20240829003045 MO Practitioner - Anesthesiology Assistant 5092980847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Emory University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Freeman-Oak Hill Health SystemGroup PAC ID 8325942253, 385 clinicians

Practice addresses (Care Compare)

1102 W 32 St
Joplin, MO 64804-3503
Phone (417) 347-4570

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
003351GAMDAnesthesiologist Assistant
2024023954MOMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Anesthesiology Associates-Pediatrics, LLC CurrentSince Jan 2, 2025 Accepting new patients
Fayette Community Anesthesia Past Accepting new patients
Piedmont Anesthesia Associates, L.L.C Past Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Locations

1130 W Michigan St
Rm 204
Indianapolis, IN 46202
Phone (317) 274-0269

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

702 Barnhill Dr
Indianapolis, IN 46202
Phone (317) 274-0273

705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1265517601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FPHO MANAGED CARE",
            "address_2": "1102 WEST 32ND STREET",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "fax_number": "417-347-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 W 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648043503",
            "telephone_number": "417-347-5222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Riley Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-274-0275",
            "fax_number": "317-274-0256",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 Peachtree St",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30308",
            "country_code": "US",
            "telephone_number": "404-778-4852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "SALLY",
        "middle_name": "ANN",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "003351",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "75000008A",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "MO",
            "license": "2024023954",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100000298B",
            "state": "DC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smitchell@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "705 Riley Hospital Dr",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462025109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.