Jerry Nelson Mixon, MD

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

MD00023643 Issued in WA

Practice address

9757 NE Juanita Dr
202
Kirkland, WA 98034-4299

Phone

(425) 605-8715

Fax

(425) 654-0211

NPI assigned

Aug 13, 2012

Last updated

Aug 13, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 14, 2015 through Aug 14, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Longevity Laboratory, LLC

  • Clinical Medical Laboratory
  • Kirkland, WA
  • NPI 1609123330
  NPD (past) Authorized official
• Longevity Medical Clinic

  • Specialist
  • Kirkland, WA
  • NPI 1023231172
  Authorized official Same address or phone

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344816000000",
    "number": "1366799090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9757 NE JUANITA DR",
            "address_2": "202",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344299",
            "telephone_number": "425-605-8715",
            "fax_number": "425-654-0211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9757 NE JUANITA DR",
            "address_2": "202",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344299",
            "telephone_number": "425-605-8715",
            "fax_number": "425-654-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIXON",
        "first_name": "JERRY",
        "middle_name": "NELSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "WA",
            "license": "MD00023643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rayna Mitchell-Rose
• Anjelette Fae Mitchell, MS, CCC-SLP
• Jenna Catherine Mitchell
• Lauren Elise Mitchell
• Laurel A Mitzel, LMP
• Dale Yoshi Miyauchi, MD
• Traci Mo, PHARM.D.
• Majed Moawad, DMD
• Alaleh Moazami, DMD
• Mina Moazzeni, DDS

• Adult Medicine Physician in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Adult Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.