Active NPI
Shalender Mittal, M.D.
- Internal Medicine Physician
- Blytheville, AR
National Provider Identifier
1447209606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- E2710
- Practice address
- 519 N 6TH St
Blytheville, AR 72315-2407 - Phone
- (870) 762-5800
- Fax
- (870) 762-5801
- NPI assigned
- May 8, 2006
- Last updated
- Apr 11, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | E2710 | AR | Primary |
Addresses
Primary practice location
519 N 6TH St
Blytheville, AR 72315-2407
Mailing address
PO Box 405
Blytheville, AR 72316-0405
Phone (870) 762-5800
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161250002 | Medicaid | AR | |
| 9360340 | Other | AR | PHCS |
| DE9450 | Other | AR | RAILROAD MEDICARE |
| 5F529 | Other | AR | BLUE CROSS |
| P00326909 | Other | AR | RAILROAD MEDICARE |
| 141358001 | Medicaid | AR | |
| 19103000000 | Other | AR | QUALCHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
519 N 6TH St
Blytheville, AR 72315-2407
Phone (870) 762-5800
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.26 of 100
- Quality
- 100
- Improvement activities
- 40
- Cost
- 77
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E2710 | AR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Medicine Associates of Blytheville PA | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/FJHBAA/Endpoint/FJHBAA
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Blytheville, AR
- NPI 1528017761
-
- Family Medicine Physician
- Blytheville, AR
- NPI 1609934249
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Elite Home Health
- Home Health Agency
- Jonesboro, AR
- NPI 1265833636
-
dba Great River Medical Center
- General Acute Care Hospital
- Blytheville, AR
- NPI 1316180748
-
dba St Bernards Medical Center
- General Acute Care Hospital
- Jonesboro, AR
- NPI 1922043686
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649635200000",
"number": "1447209606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 405",
"city": "BLYTHEVILLE",
"state": "AR",
"postal_code": "723160405",
"telephone_number": "870-762-5800",
"fax_number": "870-762-5801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "519 N 6TH ST",
"city": "BLYTHEVILLE",
"state": "AR",
"postal_code": "723152407",
"telephone_number": "870-762-5800",
"fax_number": "870-762-5801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTAL",
"first_name": "SHALENDER",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-08",
"last_updated": "2022-04-11",
"certification_date": "2022-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AR",
"license": "E2710",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "161250002",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "9360340",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DE9450",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "5F529",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00326909",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "141358001",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "19103000000",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blytheville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.