Individual provider Active NPI

Mikiyas Fitawok, CAA

  • Anesthesiologist Assistant
  • Madison, WI
National Provider Identifier
1447823075
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
Practice address
302 Samuel Dr Apt 218
Madison, WI 53717-2216
Phone
(202) 629-6468
NPI assigned
Jul 21, 2021
Last updated
Aug 6, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X TX Primary
Anesthesiologist Assistant 367H00000X 193-17 WI
Anesthesiologist Assistant 367H00000X 2000-00031 NC
Anesthesiologist Assistant 367H00000X 75000194A IN

Addresses

Primary practice location

302 Samuel Dr Apt 218
Madison, WI 53717-2216

Mailing address

302 Samuel Dr Apt 218
Madison, WI 53717-2216
Phone (202) 629-6468

Other practice location 1

1168 E Cutlar Xing Ste 101
Leland, NC 28451-6485
Phone (910) 332-1550

Other practice location 2

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (317) 274-0275

Other practice location 3

12222 Merit Dr Ste 600
Dallas, TX 75251-3294
Phone (972) 715-5000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mfitawok@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241125001611 IN Practitioner - Anesthesiology Assistant 3274937230 Reassigns benefits to 1 organization
I20260521001720 GA Practitioner - Anesthesiology Assistant 3274937230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Anesthesiology of North Carolina PLLCGroup PAC ID 2961316450, shared by 3 NPIs, 315 clinicians
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

1168 E Cutlar Xing
Suite 101
Leland, NC 28451-6485
Phone (910) 332-1550

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2000-00031NCMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group, LLC CurrentSince Dec 2, 2024 Accepting new patients

Locations

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

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.

Hospital & facility affiliations 1

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": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1447823075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 SAMUEL DR APT 218",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172216",
            "telephone_number": "202-629-6468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 SAMUEL DR APT 218",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172216",
            "telephone_number": "202-629-6468"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1168 E Cutlar Xing Ste 101",
            "address_purpose": "LOCATION",
            "city": "Leland",
            "state": "NC",
            "postal_code": "284516485",
            "country_code": "US",
            "telephone_number": "910-332-1550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021239",
            "country_code": "US",
            "telephone_number": "317-274-0275",
            "fax_number": "317-274-0256",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12222 Merit Dr Ste 600",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752513294",
            "country_code": "US",
            "telephone_number": "972-715-5000",
            "fax_number": "972-715-9976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FITAWOK",
        "first_name": "MIKIYAS",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-21",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "WI",
            "license": "193-17",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "NC",
            "license": "2000-00031",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "75000194A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mfitawok@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1701 N Senate Blvd",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.