Patrick Mitsos

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019029811 Issued in IL

Practice address

5819 E Riverside Blvd # 21
Rockford, IL 61114-4963

Phone

(815) 282-4311

Fax

(815) 282-4315

NPI assigned

Jun 11, 2014

Last updated

Jun 11, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Affordable Dentistry Today

  dba Affordable Dentistry Today - Rockford

  • General Practice Dentistry
  • Rockford, IL
  • NPI 1629393962
  NPD (past)

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1558775122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5819 E RIVERSIDE BLVD # 21",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144963",
            "telephone_number": "815-282-4311",
            "fax_number": "815-282-4315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5819 E RIVERSIDE BLVD # 21",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144963",
            "telephone_number": "815-282-4311",
            "fax_number": "815-282-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITSOS",
        "first_name": "PATRICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taha Mirza, DDS
• Stefania Teresa Missanelli, OTR
• David R. Mitchell, MD
• Jennifer Mitchell, LMFT
• Patricia Anne Mitchell, PMHNP
• Francisco J Miyares, M.D.
• MJM Medical Corp
• Matt A Mlsna, D.D.S.
• Allison Mlyniec
• Mobile Physical Therapy

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.