Individual provider Active NPI

Mita B Patel, M.D.

  • Cardiovascular Disease Physician
  • Marina del Rey, CA
National Provider Identifier
1609032986
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A150310 Issued in CA
Practice address
4676 Admiralty Way # 301
Marina del Rey, CA 90292-6601
Phone
(310) 673-3945
Fax
(310) 673-0273
NPI assigned
Aug 6, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 64496 WI
Internal Medicine Physician 207R00000X 125.054484 IL
Cardiovascular Disease Physician 207RC0000X A150310 CA Primary

Addresses

Primary practice location

4676 Admiralty Way # 301
Marina del Rey, CA 90292-6601

Mailing address

9200 W Wisconsin Ave
Division of Cardiology
Milwaukee, WI 53226-3522
Phone (414) 955-6777

Other practice location 1

9200 W Wisconsin Ave
Division of Cardiology
Milwaukee, WI 53226-3522
Phone (414) 955-6777

Other identifiers 1

IdentifierTypeStateIssuer
1609032986MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, CA2 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
I20151006003059 WI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1557512282 Reassigns benefits to 2 organizations
I20190422001385 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1557512282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Rush Medical College of Rush University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cedars-Sinai Medical Care FoundationGroup PAC ID 0941106645, 1,684 clinicians

Practice addresses (Care Compare)

4644 Lincoln Blvd
Suite 113
Marina del Rey, CA 90292-6374
Phone (310) 306-6966

Hospital & facility affiliations

  • Cedar-Sinai Marina del Rey Hospital Hospital, Marina del Rey, CA, CCN 050740
  • Cedars-Sinai Medical Center Hospital, Los Angeles, CA, CCN 050625
  • Torrance Memorial Medical Center Hospital, Torrance, CA, CCN 050351

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.054484ILMDInternal Medicine Physician
64496WIMDInternal Medicine Physician
A150310CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Internal Medicine CurrentSince Nov 1, 2015 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Internal Medicine CurrentSince Sep 15, 2013 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Sep 15, 2013 Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Mar 1, 2019 Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Community Memorial Hospital of Menomonee Falls Inc Past Accepting new patients
Froedtert Memorial Lutheran Hospital, Inc. Past Accepting new patients
Jonathan D. Rand, M.D. Inc Internal Medicine PastSince Mar 1, 2019 Accepting new patients
Community Memorial Hospital District Cardiovascular Disease Past Accepting new patients
Cedars-Sinai Marina Hospital Past Accepting new patients
St. Josephs Community Hospital of West Bend Inc. Past Accepting new patients

Locations

390 N Pacific Coast Hwy
Ste 1055
El Segundo, CA 90245

8635 W 3rd St
Ste 465W
Los Angeles, CA 90048
Phone (310) 423-0674

4676 Admiralty Way
Ste 301
Marina del Rey, CA 90292
Phone (310) 385-2992

4644 Lincoln Blvd
Ste 113
Marina del Rey, CA 90292
Phone (310) 306-6966

4644 Lincoln Blvd
Ste 102
Marina del Rey, CA 90292
Phone (310) 822-0022

1919 Santa Monica Blvd
Ste 100
Santa Monica, CA 90404
Phone (424) 314-7800

4140 W 190th St
Torrance, CA 90504
Phone (310) 967-1780

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540

3200 Pleasant Valley Rd
West Bend, WI 53095
Phone (262) 334-5533

Interoperability endpoints

  • Direct secure messaging: mpatel221476@direct.cshs.org

Organizations & group practices 12

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 4

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": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1609032986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "address_2": "DIVISION OF CARDIOLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-955-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4676 ADMIRALTY WAY # 301",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926601",
            "telephone_number": "310-673-3945",
            "fax_number": "310-673-0273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9200 W Wisconsin Ave",
            "address_2": "DIVISION OF CARDIOLOGY",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263522",
            "country_code": "US",
            "telephone_number": "414-955-6777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "MITA",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-06",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "64496",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.054484",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A150310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609032986",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marina del Rey, CA

Sources for this page

Verify at the official NPI Registry.