Individual provider Active NPI

Travis Mitchell, MD

  • Ophthalmology Physician
  • Detroit, MI
National Provider Identifier
1568083566
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
4301511367 Issued in MI
Practice address
4717 Saint Antoine St
Detroit, MI 48201-1423
Phone
(313) 577-8900
NPI assigned
Apr 30, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 4301511367 MI Primary

Addresses

Primary practice location

4717 Saint Antoine St
Detroit, MI 48201-1423

Mailing address

400 Mack Ave
Detroit, MI 48201-2136

Other practice location 1

3901 Rainbow Blvd # MS 2027
Kansas City, KS 66160-8500
Phone (913) 588-6050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240610000723 MI Practitioner - Ophthalmology 5890119952 Reassigns benefits to 1 organization
I20260317002030 TX Practitioner - Ophthalmology 5890119952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Baylor College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4717 Saint Antoine St
Detroit, MI 48201-1423
Phone (313) 577-8900

Hospital & facility affiliations

  • Harper University Hospital Hospital, Detroit, MI, CCN 230104

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group Ophthalmology CurrentSince Jun 1, 2024 Accepting new patients
Texan Eye, PA Ophthalmology CurrentSince Apr 1, 2026 Accepting new patients
Texan Eye, P.a. CurrentSince Apr 1, 2026 Accepting new patients
University Physician Group Past Accepting new patients

Locations

400 Mack Ave
Detroit, MI 48201
Phone (313) 448-9006

4717 Saint Antoine St
Detroit, MI 48201
Phone (313) 577-7614

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

5717 Balcones Dr
Austin, TX 78731
Phone (512) 314-1613

925 Starwood Dr
Cedar Park, TX 78613

Interoperability endpoints

  • Direct secure messaging: travis.mitchell.1@19711.direct.athenahealth.com
  • Direct secure messaging: tmitchell1141829@direct.hfhs.org

Organizations & group practices 4

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": "1588204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1568083566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4717 SAINT ANTOINE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011423",
            "telephone_number": "313-577-8900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 Rainbow Blvd # MS 2027",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "KS",
            "postal_code": "661608500",
            "country_code": "US",
            "telephone_number": "913-588-6050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "TRAVIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-30",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301511367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.