Active NPI
Samuel J Mitchell, MD
- Family Medicine Physician
- Bozeman, MT
National Provider Identifier
1346295060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 10813
- Practice address
- 1 Swingle Student Health Service
Montana State University
Bozeman, MT 59717-3260 - Phone
- (406) 994-2311
- Fax
- (406) 994-2504
- NPI assigned
- May 23, 2006
- Last updated
- Feb 8, 2013
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10813 | MT | Primary |
Addresses
Primary practice location
1 Swingle Student Health Service
Montana State University
Bozeman, MT 59717-3260
Mailing address
PO Box 173260
Montana State University Student Health Service
Bozeman, MT 59717-3260
Phone (406) 994-2311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0144781 | Medicaid | MT |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10813 | MT | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360281600000",
"number": "1346295060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 173260",
"address_2": "MONTANA STATE UNIVERSITY STUDENT HEALTH SERVICE",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597173260",
"telephone_number": "406-994-2311",
"fax_number": "406-994-2504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 SWINGLE STUDENT HEALTH SERVICE",
"address_2": "MONTANA STATE UNIVERSITY",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597173260",
"telephone_number": "406-994-2311",
"fax_number": "406-994-2504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "SAMUEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-23",
"last_updated": "2013-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MT",
"license": "10813",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0144781",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.