Individual provider Active NPI

Mikel P Vartanian

  • Physician Assistant
  • Mobile, AL
National Provider Identifier
1457004012
Registry record updated Aug 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2197 Issued in AL
Practice address
8501 Tanner Williams Rd
Mobile, AL 36608-8322
Phone
(251) 441-6401
NPI assigned
Feb 2, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2197 AL Primary
Physician Assistant 363A00000X PA9115801 FL

Addresses

Primary practice location

8501 Tanner Williams Rd
Mobile, AL 36608-8322

Mailing address

8501 Tanner Williams Rd
Mobile, AL 36608-8322
Phone (251) 441-6878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230323003118 AL Practitioner - Physician Assistant 1850765348 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2197ALMDRegistered Dietitian
PA9115801FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Urgent Care LLC CurrentSince Apr 1, 2023 Accepting new patients
Mobile Emergency Physicians, LLC CurrentSince Oct 20, 2025 Accepting new patients

Locations

6801 Airport Blvd
Mobile, AL 36608
Phone (251) 266-3580

4682 Airport Blvd
Mobile, AL 36608
Phone (251) 342-4900

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1643760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722729600000",
    "number": "1457004012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8501 TANNER WILLIAMS RD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366088322",
            "telephone_number": "251-441-6878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 TANNER WILLIAMS RD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366088322",
            "telephone_number": "251-441-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARTANIAN",
        "first_name": "MIKEL",
        "middle_name": "P",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-02",
        "last_updated": "2024-08-04",
        "certification_date": "2024-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "2197",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115801",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

Verify at the official NPI Registry.