Active NPI
Major Joseph Mittendorf, PA-C
- Physician Assistant
- Baton Rouge, LA
National Provider Identifier
1295969467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- A10250
- Practice address
- 12091 Bricksome Ave
Baton Rouge, LA 70816-2699 - Phone
- (225) 756-2673
- NPI assigned
- May 4, 2009
- 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 | A10250 | LA | Primary |
Addresses
Primary practice location
12091 Bricksome Ave
Baton Rouge, LA 70816-2699
Mailing address
15960 Highland Rd
Baton Rouge, LA 70810-6512
Phone (225) 752-2276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A10250 | LA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241395200000",
"number": "1295969467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15960 HIGHLAND RD",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708106512",
"telephone_number": "225-752-2276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12091 BRICKSOME AVE",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708162699",
"telephone_number": "225-756-2673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTENDORF",
"first_name": "MAJOR",
"middle_name": "JOSEPH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-05-04",
"last_updated": "2009-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "LA",
"license": "A10250",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.