Jennifer B Mitsuya, D.O.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

5101019846 Issued in MI

Practice address

3535 W 13 Mile Rd Ste 707
Royal Oak, MI 48073

Phone

(248) 551-0487

Fax

(248) 551-3696

NPI assigned

Apr 2, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer M. Bordato Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jbordato58592@direct.hfhs.org
• Direct secure messaging: jmitsuya1247240@epic00.shdirect.org
• Direct secure messaging: jmitsuya767932@direct.beaumont.edu

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.

• Beaumont Medical Group- Specialty Services

  • Surgery Physician
  • Royal Oak, MI
  • NPI 1578072906
  Medicare reassignment NPD

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1336405554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BOULEVARD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48033",
            "telephone_number": "947-522-1858",
            "fax_number": "248-350-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 W 13 MILE RD STE 707",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "48073",
            "telephone_number": "248-551-0487",
            "fax_number": "248-551-3696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 Beaubien St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012119",
            "country_code": "US",
            "telephone_number": "313-745-5533",
            "fax_number": "313-993-7118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITSUYA",
        "first_name": "JENNIFER",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-02",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "MI",
            "license": "5101019846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmitsuya767932@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "3535 W 13 Mile Rd Ste 707",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BORDATO",
            "middle_name": "M.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alazia Mitchell
• Dawn Marie Mitchell, MSN
• Rachel Mitchell
• Sarah Mitchell
• Carol Mitri, MD
• Emlily Kathryn Mlynarek, PA
• Mujtaba Moazzam, M.D.
• Mobile Medical Consultant PLLC
• Mobile Physical Therapy LLC
• Hiba Mobin, M.D.

• Pediatric Gastroenterology Physician in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Pediatric Gastroenterology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.