Individual provider Active NPI

Andrew Mitchell, MD

  • Pediatrics Physician
  • Dayton, OH
National Provider Identifier
1366903403
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35.151532 Issued in OH
Practice address
1816 Harvard Blvd Ste 202
Dayton, OH 45406-4539
Phone
(937) 641-4000
Fax
(937) 641-4500
NPI assigned
Mar 29, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.151532 OH Primary

Addresses

Primary practice location

1816 Harvard Blvd Ste 202
Dayton, OH 45406-4539

Mailing address

PO Box 933432
Cleveland, OH 44193-0039
Phone (937) 641-3555

Other practice location 1

171 Deeds Park Dr
Dayton, OH 45404-6500
Phone (937) 800-1235

Other identifiers 1

IdentifierTypeStateIssuer
0482747MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20240807000554 OH Practitioner - Pediatric Medicine 8325371321 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.151532OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Children'S Specialty Physicians, Inc. Pediatrics CurrentSince Aug 1, 2024 Accepting new patients
Dayton Children'S Specialty Physicians, Inc. Pediatrics CurrentSince Jul 28, 2024 Accepting new patients

Locations

171 Deeds Park Dr
Dayton, OH 45404
Phone (833) 378-4827

1816 Harvard Blvd
Ste 202
Dayton, OH 45406
Phone 9376413401 ext. 2

1 Childrens Plz
Dayton, OH 45404
Phone (937) 641-3600

1816 Harvard Blvd
Dayton, OH 45406

967 Bellefontaine Ave
Lima, OH 45804
Phone (419) 224-1330

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1366903403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933432",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-3555",
            "fax_number": "937-641-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1816 HARVARD BLVD STE 202",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454064539",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Deeds Park Dr",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454046500",
            "country_code": "US",
            "telephone_number": "937-800-1235",
            "fax_number": "937-800-1237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.151532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0482747",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.