Individual provider Active NPI

Mitchell Haven Katz, MD

  • Pediatric Gastroenterology Physician
  • Orange, CA
National Provider Identifier
1366530107
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
G46842 Issued in CA
Practice address
455 S Main St
Orange, CA 92868-3835
Phone
(714) 289-4099
Fax
(714) 516-4299
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Gastroenterology Physician 2080P0206X G46842 CA Primary

Addresses

Primary practice location

455 S Main St
Orange, CA 92868-3835

Mailing address

455 S Main St
Orange, CA 92868-3835
Phone (714) 289-4511

Other identifiers 1

IdentifierTypeStateIssuer
00G468420MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20101026000471 CA Practitioner - Pediatric MedicinePractitioner - Gastroenterology 0749473478 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G46842CAMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital of Orange County Pediatric Gastroenterology CurrentSince Oct 13, 2018 Accepting new patients
Memorial Medical Group Inc Past Accepting new patients

Locations

500 Superior Ave
Ste 140
Newport Beach, CA 92663
Phone (949) 631-3603

455 S Main St
Orange, CA 92868
Phone (714) 289-4511

725 W La Veta Ave
Ste 100
Orange, CA 92868
Phone (714) 633-6363

1100 W Stewart Dr
Orange, CA 92868
Phone (714) 532-8620

1201 W La Veta Ave
Orange, CA 92868
Phone (714) 509-8481

Dept LA 21333
Pasadena, CA 91185

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366530107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683835",
            "telephone_number": "714-289-4511",
            "fax_number": "714-289-4788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 S MAIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683835",
            "telephone_number": "714-289-4099",
            "fax_number": "714-516-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATZ",
        "first_name": "MITCHELL",
        "middle_name": "HAVEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "CA",
            "license": "G46842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G468420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.