Active NPI
Jeffrey Raymond Mitchell, MD
- Child & Adolescent Psychiatry Physician
- Albuquerque, NM
National Provider Identifier
1568442135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 20708
- Practice address
- 8312 Kaseman CT NE
Presbyterian, Outpatient Child BH Clinic
Albuquerque, NM 87110-7639 - Phone
- (505) 291-5300
- Fax
- (505) 559-6130
- NPI assigned
- Jan 19, 2006
- Last updated
- Dec 13, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 20708 | OK | Primary |
Addresses
Primary practice location
8312 Kaseman CT NE
Presbyterian, Outpatient Child BH Clinic
Albuquerque, NM 87110-7639
Mailing address
8312 Kaseman CT NE
Child and Adolescent Behavioral Health Clinic
Albuquerque, NM 87110-7639
Phone (505) 291-5300
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100029450A | Medicaid | OK | |
| 2017759 | Other | CIGNA BEHAVIORAL HEALTH | |
| 7411192 | Other | AETNA BEHAVIORAL HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20708 | OK | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355356800000",
"number": "1568442135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8312 KASEMAN CT NE",
"address_2": "CHILD AND ADOLESCENT BEHAVIORAL HEALTH CLINIC",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871107639",
"telephone_number": "505-291-5300",
"fax_number": "505-559-6130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8312 KASEMAN CT NE",
"address_2": "PRESBYTERIAN, OUTPATIENT CHILD BH CLINIC",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871107639",
"telephone_number": "505-291-5300",
"fax_number": "505-559-6130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "JEFFREY",
"middle_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2012-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "OK",
"license": "20708",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100029450A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTH",
"identifier": "2017759",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA BEHAVIORAL HEALTH",
"identifier": "7411192",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.