NPIMap

Individual provider Active NPI

Kristen Mix, DNP, AGACNP

  • Acute Care Nurse Practitioner
  • Clinton Township, MI
National Provider Identifier
1487256426
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704285817 Issued in MI
Practice address
15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone
(586) 263-2300
NPI assigned
Nov 13, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 4704285817 MI
Acute Care Nurse Practitioner 363LA2100X 4704285817 MI Primary

Addresses

Primary practice location

15855 19 Mile Rd
Clinton Township, MI 48038-3504

Mailing address

950 Sherry Dr
Lake Orion, MI 48362-2870

Other practice location 1

950 Sherry Dr
Lake Orion, MI 48362-2870
Phone (248) 635-0962

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20220719003025 MI Practitioner - Nurse Practitioner 7113308305 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pioneer Medical Associates PCGroup PAC ID 2860743309, 23 clinicians

Practice addresses (Care Compare)

27560 Hoover Rd
Warren, MI 48093-4505
Phone (586) 573-5890

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704285817MIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Paramount Medical Group PC Current Accepting new patients
Henry Ford Macomb Hospital Corporation Nurse Practitioner Current Accepting new patients
Henry Ford Macomb Hospital Corporation Nurse Practitioner CurrentSince Jul 15, 2022 Accepting new patients
Pioneer Endoscopy & Surgery Center, L.L.C. CurrentSince Jun 26, 2023 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Jul 15, 2022 Accepting new patients
Pioneer Medical Associates P.C. Nurse Practitioner CurrentSince Jun 26, 2023 Accepting new patients
St. Clair Medical Associates, P.C. Past Accepting new patients

Locations

30795 23 Mile Rd
Chesterfield, MI 48047
Phone (586) 421-3000

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

15945 19 Mile Rd
Ste 204
Clinton Twp, MI 48038
Phone (586) 757-6400

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

27560 Hoover Rd
Warren, MI 48093
Phone (586) 573-5890

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDIBBA
  • Direct secure messaging: kmix793263@direct.hfhs.org

Organizations & group practices 7

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 4

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": "1605225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1487256426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 SHERRY DR",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483622870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-263-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "950 Sherry Dr",
            "address_purpose": "LOCATION",
            "city": "Lake Orion",
            "state": "MI",
            "postal_code": "483622870",
            "country_code": "US",
            "telephone_number": "248-635-0962",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIX",
        "first_name": "KRISTEN",
        "credential": "DNP,  AGACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-13",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "MI",
            "license": "4704285817",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704285817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.