Active NPI
Mansel K Kevwitch, M.D.
- Specialist
- Anacortes, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MD00030853
- Practice address
- 1211 24TH St
Anacortes, WA 98221-2562 - Phone
- (360) 299-4945
- Fax
- (360) 299-1339
- NPI assigned
- Nov 2, 2006
- Last updated
- Jul 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | MD00030853 | WA | Primary |
Addresses
Primary practice location
1211 24TH St
Anacortes, WA 98221-2562
Mailing address
1211 24TH St
Anacortes, WA 98221-2562
Phone (360) 299-4945
Other practice location 1
1730 E Division St
Mount Vernon, WA 98274-4549
Phone (360) 428-7777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083815 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA, ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Urology
- Education
- University of Michigan Medical School, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Prostate resection | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health, LLC. | Current | Accepting new patients | |
| Innovis Health LLC | Current | Accepting new patients | |
| Innovis Health, LLC | Current | Accepting new patients |
Locations
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Ambulatory Surgical Clinic/Center
- Bellingham, WA
- NPI 1043690126
-
dba Essentia Health-Osgood Clinic
- Multi-Specialty Clinic/Center
- Fargo, ND
- NPI 1144776576
-
dba Essentia Health Lisbon Clinic
- Family Medicine Physician
- Lisbon, ND
- NPI 1043490790
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Essentia Health St. Mary's-Frazee Clinic
- Rural Health Clinic/Center
- Frazee, MN
- NPI 1902364482
Hospital
-
dba Essentia Health Park Rapids Hwy 34 Clinic
- Rural Health Clinic/Center
- Park Rapids, MN
- NPI 1730706656
Hospital
-
dba Essentia Health St. Mary's- Detroit Lakes
- Rural Acute Care Hospital
- Detroit Lakes, MN
- NPI 1679561088
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596067200000",
"number": "1568540771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 24TH ST",
"city": "ANACORTES",
"state": "WA",
"postal_code": "982212562",
"telephone_number": "360-299-4945",
"fax_number": "360-299-1339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 24TH ST",
"city": "ANACORTES",
"state": "WA",
"postal_code": "982212562",
"telephone_number": "360-299-4945",
"fax_number": "360-299-1339"
}
],
"practiceLocations": [
{
"address_1": "1730 E Division St",
"address_purpose": "LOCATION",
"city": "Mount Vernon",
"state": "WA",
"postal_code": "982744549",
"country_code": "US",
"telephone_number": "360-428-7777",
"fax_number": "360-428-7704",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KEVWITCH",
"first_name": "MANSEL",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2020-07-30",
"certification_date": "2020-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MD00030853",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1083815",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anacortes, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.