NPIMap

Individual provider Active NPI

Courtney Ann Mitchell, FNP-C

  • Family Nurse Practitioner
  • Bullhead City, AZ
National Provider Identifier
1376141424
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
248633 Issued in AZ
Practice address
2182 Highway 95
Bullhead City, AZ 86442-6044
Phone
(928) 758-6420
NPI assigned
Oct 12, 2020
Last updated
Oct 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 248633 AZ Primary

Addresses

Primary practice location

2182 Highway 95
Bullhead City, AZ 86442-6044

Mailing address

2182 Highway 95
Bullhead City, AZ 86442-6044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211215002491 OR Practitioner - Nurse Practitioner 1759792559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Icco LLCGroup PAC ID 1355406729, 133 clinicians

Practice addresses (Care Compare)

2902 Tom Tennant Dr
Woodburn, OR 97071-2828
Phone (541) 640-7625

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.16 of 100Reported as group
Quality
84.81
Promoting interoperability
100
Improvement activities
40
Cost
75.71

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icco, LLC Current Accepting new patients
Icco, LLC CurrentSince Jun 3, 2024 Accepting new patients
Icco LLC CurrentSince Jun 3, 2024 Accepting new patients
Zegarra Hospital and Nursing Home Services PLLC PastSince May 24, 2020 Accepting new patients

Locations

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

3675 Pacific Ave
#101
Forest Grove, OR 97116
Phone (971) 762-4611

1890 NW 6th St
Grants Pass, OR 97526
Phone (541) 507-0684

3737 Shasta Way
Ste A
Klamath Falls, OR 97603
Phone (541) 883-2337

3400 Cooperative Way
Lebanon, OR 97355
Phone (541) 333-6605

Organizations & group practices 4

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.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1376141424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2182 HIGHWAY 95",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864426044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2182 HIGHWAY 95",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864426044",
            "telephone_number": "928-758-6420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "COURTNEY",
        "middle_name": "ANN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-12",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "248633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bullhead City, AZ

Sources for this page

Verify at the official NPI Registry.