Active NPI
Mitchell Davis
- Perfusionist
- Chaska, MN
National Provider Identifier
1386054039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- Q307148741310
- Practice address
- 111312 Village Rd
Chaska, MN 55318-1385 - Phone
- (650) 321-9999
- NPI assigned
- May 4, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Perfusionist | 242T00000X | Q307148741310 | CA | Primary |
Addresses
Primary practice location
111312 Village Rd
Chaska, MN 55318-1385
Mailing address
111312 Village Rd
Chaska, MN 55318-1385
Phone (952) 221-2237
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Q307148741310 | CA | MD | Perfusionist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Health | Current | Accepting new patients |
Interoperability endpoints
- mdavis35760@scrippshlth.medalliesdirect.net
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- San Diego, CA
- NPI 1487928891
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399161600000",
"number": "1386054039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111312 VILLAGE RD",
"city": "CHASKA",
"state": "MN",
"postal_code": "553181385",
"telephone_number": "952-221-2237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111312 VILLAGE RD",
"city": "CHASKA",
"state": "MN",
"postal_code": "553181385",
"telephone_number": "650-321-9999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MITCHELL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-04",
"last_updated": "2014-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "CA",
"license": "Q307148741310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chaska, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.