Individual provider Active NPI

Justin Patrick Mitchelson, M.D.

  • Emergency Medicine Physician
  • Grosse Pointe, MI
National Provider Identifier
1598994139
Registry record updated Jul 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301111177 Issued in MI
Practice address
468 Cadieux Rd
Beaumont Hospital - Grosse Pointe
Grosse Pointe, MI 48230-1507
Phone
(313) 473-1605
Fax
(313) 473-1934
NPI assigned
Jul 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301111177 MI Primary
Emergency Medicine Physician 207P00000X R71686 AZ

Addresses

Primary practice location

468 Cadieux Rd
Beaumont Hospital - Grosse Pointe
Grosse Pointe, MI 48230-1507

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Other practice location 1

36555 26 Mile Rd Ste 1100
Lenox, MI 48048-3186
Phone (947) 523-4040

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmitchelson446771@direct.beaumont.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20161221000154 MI Practitioner - Emergency Medicine 3870741747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Michigan Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beaumont Medical Group Hospital Based ServicesGroup PAC ID 3072875889, 575 clinicians

Practice addresses (Care Compare)

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-1187

44201 Dequindre Rd Ec
Beaumont Emergency Services TR
Troy, MI 48085-1117
Phone (248) 964-5111

468 Cadieux Rd
Grosse Pointe, MI 48230-1507
Phone (313) 473-1605

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.64 of 100Reported as group
Quality
85.06
Promoting interoperability
100
Improvement activities
40
Cost
77.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R71686AZMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaumont Medical Group Hospital -Based Services CurrentSince Mar 3, 2018 Accepting new patients

Locations

468 Cadieux Rd
Grosse Pt Wds, MI 48230
Phone (313) 343-1000

36555 26 Mile Rd
Ste 1100
Lenox, MI 48048
Phone (947) 523-4010

26901 Beaumont Blvd
Ste 3D
Southfield, MI 48033
Phone (947) 522-1860

44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255

Interoperability endpoints

  • Direct secure messaging: jmitchelson1247234@epic00.shdirect.org

Organizations & group practices 1

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 2

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": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659052800000",
    "number": "1598994139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "468 CADIEUX RD",
            "address_2": "BEAUMONT HOSPITAL - GROSSE POINTE",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301507",
            "telephone_number": "313-473-1605",
            "fax_number": "313-473-1934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36555 26 Mile Rd Ste 1100",
            "address_purpose": "LOCATION",
            "city": "Lenox",
            "state": "MI",
            "postal_code": "480483186",
            "country_code": "US",
            "telephone_number": "947-523-4040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELSON",
        "first_name": "JUSTIN",
        "middle_name": "PATRICK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-02",
        "last_updated": "2022-07-29",
        "certification_date": "2022-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301111177",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "R71686",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmitchelson446771@direct.beaumont.org",
            "affiliation": "N",
            "address_1": "468 Cadieux Rd",
            "address_2": "Beaumont Hospital - Grosse Pointe",
            "city": "Grosse Pointe",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482301507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grosse Pointe, MI

Sources for this page

Verify at the official NPI Registry.