Idol Ray Mitchell, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016-004683 Issued in IL

Practice address

437 East Grant Street
Macomb, IL 61455-3352

Phone

(309) 837-3964

Fax

(309) 837-3966

NPI assigned

Sep 6, 2005

Last updated

May 15, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

College of Podiatric Med and Surgery, Des Moines University, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Blessing HospitalGroup PAC ID 3072422534, 414 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• MC Donough District Hospital Hospital, Macomb, IL, CCN 140089

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/9c9d3cdf-0f7f-4b63-979a-f711747b3e95/
• FHIR API: https://fhir.blessinghospital.com/R4/open-Prod
• Direct secure messaging: idolmitchell@bcs.allscriptsdirect.net
• Direct secure messaging: idolmitchell@blessing.allscriptsdirect.net

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.

• Blessing Hospital

  • Multi-Specialty Clinic/Center
  • Quincy, IL
  • NPI 1114471737
  Medicare reassignment Care Compare group NPD
• McDonough County Hospital District

  dba McDonough Eye Care

  • Internal Medicine Physician
  • Macomb, IL
  • NPI 1609180082
  Medicare reassignment NPD
• McDonough County Hospital District

  dba McDonough District Hospital

  • General Acute Care Hospital
  • Macomb, IL
  • NPI 1669420766
  Medicare reassignment NPD
• Idol R Mitchell DPM PC

  • Podiatrist
  • Macomb, IL
  • NPI 1003987173
  Authorized official Same address or phone
• Blessing Hospital

  • General Acute Care Hospital
  • Quincy, IL
  • NPI 1760571699
  NPD
• McDonough County Hospital District

  • Emergency Medicine Physician
  • Macomb, IL
  • NPI 1013048982
  NPD
• McDonough County Hospital District

  dba MDH Community Pharmacy

  • Community/Retail Pharmacy
  • Macomb, IL
  • NPI 1245098458
  NPD
• McDonough County Hospital District

  dba McDonough Medical Group

  • Anatomic Pathology & Clinical Pathology Physician
  • Macomb, IL
  • NPI 1396055869
  NPD
• McDonough County Hospital District

  dba McDonough District Hospital

  • General Acute Care Hospital
  • Macomb, IL
  • NPI 1629227665
  NPD
• McDonough County Hospital District

  dba McDonough District Hospital

  • General Acute Care Hospital
  • Macomb, IL
  • NPI 1790934735
  NPD
• McDonough County Hospital District

  dba McDonough District Hospital

  • Certified Registered Nurse Anesthetist
  • Macomb, IL
  • NPI 1871704874
  NPD
• Quincy Clinical Laboratory Services SC

  • Anatomic Pathology & Clinical Pathology Physician
  • Quincy, IL
  • NPI 1114773272
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McDonough County Hospital District

  dba McDonough District Hospital

  • General Acute Care Hospital
  • Macomb, IL
  • NPI 1669420766
  Care Compare affiliation

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1508850694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 EAST GRANT STREET",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553352",
            "telephone_number": "309-837-3964",
            "fax_number": "309-837-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 EAST GRANT STREET",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553352",
            "telephone_number": "309-837-3964",
            "fax_number": "309-837-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "IDOL",
        "middle_name": "RAY",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016-004683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004683",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "214428",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROV #",
            "identifier": "480034728",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4452210001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David L Miller, D.O.
• Shane Michael Miller, PHARMD
• Mind Body Integrative Counseling PLLC
• Richard Earl Minter, D.O.
• Mitch and Chris Standard Inc. (Macomb Audiology and Hearing Aid Center)
• Alison K Mixer, OTR/L
• MMB Dialysis, LLC (d/b/a Macomb Dialysis)
• Chrystal Marie Montroy, COTA/L
• Elizabeth Jane Morris, ATHLETIC TRAINER
• Mosaic

• Podiatrist in Macomb, IL
• Providers in Macomb, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.

Verify at the official NPI Registry.