Mitchell S McTavish, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6716 Issued in CT

Practice address

267 Grant St
Bridgeport, CT 06610-2805

Phone

(203) 384-3145

NPI assigned

Oct 25, 2017

Sex

Male

Sole proprietor

No

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

Enrolled in CO, CT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/4045/brand/3/csg/61/fhir/r4
• Direct secure messaging: mmctavish709420@direct.ynhh.org
• FHIR API: https://api.platform.athenahealth.com/1922/brand/1/csg/1/fhir/r4

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.

• Yale University

  dba Yale Medicine

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236
  Medicare reassignment NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD
• Platte River Medical Clinic LLC

  • Family Medicine Physician
  • Brighton, CO
  • NPI 1477667244
  NPD
• Childen's Community Care

  dba Children's Community Pediatrics

  • Pediatrics Physician
  • Moon Township, PA
  • NPI 1063429678
  NPD (past)
• Childrens Community Pediatrics

  • Pediatrics Physician
  • Monroeville, PA
  • NPI 1740244110
  NPD (past)

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

{
    "created_epoch": "1508889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1386156891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCTAVISH",
        "first_name": "MITCHELL",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-25",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "6716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig A McPherson, M.D.
• Keith McPherson, LMSW
• Patricia McSherry, CAC
• Clifton McSwain II
• Elana Chloe McTavish, PA-C
• Medi Spark LLC
• Rafael Mediavilla, M.S-ESL
• Medical Center Pharmacy and Home Care Center, Inc. (Yale New Haven Health Pharmacy Bridgeport Hospital)
• Medical Specialists of Fairfield, LLC (SWIM Hematology Oncology)
• Julia Emma Medina, PA-C

• Physician Assistant in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.