Ingrid Dominic Mitchell, P.A.
Individual provider Active NPI Medical Physician Assistant · Detroit, MI
NPI 1295750677 · NPPES record last updated Jun 1, 2016
Key facts
- NPI
- 1295750677
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 5601003504 (MI)
- Practice address
- 18254 Livernois Ave Ste 1
Detroit, MI 48221-4214 - Phone
- (313) 861-4400
- Fax
- (248) 336-9137
- NPI assigned
- Jul 13, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 12
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040225000251 | MI | Practitioner - Physician Assistant | 3678469889 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601003504 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Botsford General Hospital | Current |
Accepting new patients | |
| Signify Health Medical Associates, PLLC | Current |
Accepting new patients | |
| Healthland Housecall Services LLC | Past |
Accepting new patients | |
| Total Health Care Professionals, PLLC | Past | Accepting new patients | |
| Healthland P C | Past |
Accepting new patients | |
| Epic Primary Care II PLLC | Physician Assistant | Past |
Accepting new patients |
| Mme Enterprises Inc | Past | Accepting new patients | |
| Detroit Recovery Project | Past | Accepting new patients | |
| Socialaspect Consulting Agency Inc | Past | Accepting new patients | |
| At Home Physicians Managing Co | Past |
Accepting new patients | |
| Professional Medical Center PC | Past | Accepting new patients |
Locations
13 N Washington St
Ypsilanti, MI 48197
Phone (734) 329-4620
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Interoperability endpoints
- imitchell@landmarkhealth-direct.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601003504 | MI | Yes |
Addresses
Primary practice location
18254 Livernois Ave Ste 1
Detroit, MI 48221-4214
Mailing address
390 Enterprise CT
Suite 103
Bloomfield Hills, MI 48302-0320
Phone (248) 336-4000
Other providers in Detroit, MI
- Connie L Mitchell
- Deborah Mitchell
- Deborah Mitchell
- Felicia Mitchell
- Giordano Bruno Mitchell
- Jack Mitchell
- Jamika Mitchell
- Jenneatta Mitchell
- Jimmie Mitchell III
- John Daniel Mitchell
All providers in Detroit, MI · Medical Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.