NPIMap

Individual provider Active NPI

Jonathan Christopher Mitchell, MD

  • Obstetrics & Gynecology Physician
  • Puyallup, WA
National Provider Identifier
1386684405
Registry record updated Dec 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD00041368 Issued in WA
Practice address
11102 Sunrise Blvd E
Suite 110
Puyallup, WA 98374-8846
Phone
(253) 697-7350
Fax
(253) 841-5962
NPI assigned
Jun 7, 2006
Last updated
Dec 7, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD00041368 WA Primary

Addresses

Primary practice location

11102 Sunrise Blvd E
Suite 110
Puyallup, WA 98374-8846

Mailing address

PO Box 40
Puyallup, WA 98371-0137
Phone (253) 697-5502

Other identifiers 6

IdentifierTypeStateIssuer
0141390OtherWAL & I PROVIDER NUMBER
1121MIOtherWAREGENCE RIDER NUMBER
7699536OtherWAAETNA PROVIDER NUMBER
8316432MedicaidWA
911203494BXOtherWAKPS PROVIDER NUMBER
98375E004OtherWATRICARE PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20050314000373 WA Practitioner - Obstetrics/Gynecology 1456306414 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Medical College of Ohio, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 697-1962

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Jan 1, 2008 Accepting new patients
Multicare Health System CurrentSince Jan 1, 2008 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Past Accepting new patients
Good Samaritan Community Healthcare Obstetrics & Gynecology Past Accepting new patients
Multicare Health System Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

407 14th Ave SE
Puyallup, WA 98372
Phone (253) 697-4000

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • Direct secure messaging: jmitchellmd7061@direct.multicare.org

Organizations & group practices 6

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323216000000",
    "number": "1386684405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983710137",
            "telephone_number": "253-697-5502",
            "fax_number": "253-697-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11102 SUNRISE BLVD E",
            "address_2": "SUITE 110",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983748846",
            "telephone_number": "253-697-7350",
            "fax_number": "253-841-5962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JONATHAN",
        "middle_name": "CHRISTOPHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD00041368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I PROVIDER NUMBER",
            "identifier": "0141390",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RIDER NUMBER",
            "identifier": "1121MI",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "7699536",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8316432",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KPS PROVIDER NUMBER",
            "identifier": "911203494BX",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PROVIDER NUMBER",
            "identifier": "98375E004",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.