Individual provider Active NPI

Shanti Renee Mitchell, M.D.

  • Child & Adolescent Psychiatry Physician
  • Novi, MI
National Provider Identifier
1467715110
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
4301101308 Issued in MI
Practice address
39450 W 12 Mile Rd
Novi, MI 48377-3600
Phone
(248) 661-7393
NPI assigned
Jun 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301101308 MI
Child & Adolescent Psychiatry Physician 2084P0804X 4301101308 MI Primary

Addresses

Primary practice location

39450 W 12 Mile Rd
Novi, MI 48377-3600

Mailing address

39450 W 12 Mile Rd
Novi, MI 48377-3600
Phone (248) 661-7393

Other practice location 1

1500 E Medical Center Dr
MCHC, F6135
Ann Arbor, MI 48109-5000
Phone (734) 764-6875

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smitchell468113@direct.hfhs.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160616001275 MI Practitioner - Psychiatry 4082921044 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
State University of Ny Upstate Medical University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

39450 W 12 Mile Rd
Novi, MI 48377-3600
Phone (248) 344-6688

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301101308MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Psychiatry CurrentSince Jun 18, 2017 Accepting new patients
Chelsea Community Hospital Psychiatry Current Accepting new patients
Chelsea Community Hospital CurrentSince May 14, 2016 Accepting new patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System CurrentSince Jun 18, 2017 Accepting new patients

Locations

1500 E Medical Center Dr
#F6135
Ann Arbor, MI 48109
Phone (734) 615-0199

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

39450 W Twelve Mile Rd
Novi, MI 48377
Phone (248) 344-0710

5301 McAuley Dr
#69504
Ypsilanti, MI 48197
Phone (734) 712-2419

Interoperability endpoints

  • Direct secure messaging: smitchell468113@direct.hfhs.org

Organizations & group practices 5

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.

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": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1467715110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39450 W 12 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483773600",
            "telephone_number": "248-661-7393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39450 W 12 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483773600",
            "telephone_number": "248-661-7393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 E Medical Center Dr",
            "address_2": "MCHC, F6135",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481095000",
            "country_code": "US",
            "telephone_number": "734-764-6875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "SHANTI",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301101308",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MI",
            "license": "4301101308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smitchell468113@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "2799 W Grand Blvd",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482022608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.