Individual provider Active NPI

Mitchell K Rauch, M.D.

  • Urology Physician
  • Boca Raton, FL
National Provider Identifier
1639191190
Registry record updated May 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME0068700 Issued in FL
Practice address
670 Glades Road
Suite 200
Boca Raton, FL 33431
Phone
(561) 391-6470
Fax
(561) 394-2306
NPI assigned
Jul 24, 2006
Last updated
May 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X ME0068700 FL Primary

Addresses

Primary practice location

670 Glades Road
Suite 200
Boca Raton, FL 33431

Mailing address

150 Clinic Ave
Ste 202
Carrollton, GA 30117-4402
Phone (678) 390-7164

Other identifiers 10

IdentifierTypeStateIssuer
253485100MedicaidFL
42722OtherFLBCBS
1453279OtherFLCIGNA
259384OtherFLAVMED
P01606320OtherFLRR MEDICARE
0E640OtherFLWELLCARE
P1035782OtherFLFREEDOM
P971547OtherFLOPTIMUM
4386OtherFLDIMENSION HEALTH
5682670OtherFLAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20180703002697 GA Practitioner - Urology 2264530344 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Albany Medical College of Union University, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tanner Medical Group IncGroup PAC ID 2769536143, 120 clinicians

Practice addresses (Care Compare)

150 Clinic Ave
Suite 202
Carrollton, GA 30117-4402
Phone (770) 834-6988

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0068700FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc CurrentSince May 1, 2023 Accepting new patients
West Georgia Urology Associates PC Urology CurrentSince Jun 25, 2018 Accepting new patients
Genesiscare USA of Florida LLC Urology Past Accepting new patients

Locations

150 Clinic Ave
Ste 202
Carrollton, GA 30117
Phone (770) 834-6968

150 Clinic Ave
Ste 203
Carrollton, GA 30117
Phone (770) 834-0613

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

705 Dallas Hwy
Ste 205
Villa Rica, GA 30180
Phone (770) 771-5235

Organizations & group practices 3

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.

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525651200000",
    "number": "1639191190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE",
            "address_2": "STE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174402",
            "telephone_number": "678-390-7164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 GLADES ROAD",
            "address_2": "SUITE 200",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "33431",
            "telephone_number": "561-391-6470",
            "fax_number": "561-394-2306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAUCH",
        "first_name": "MITCHELL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2018-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME0068700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253485100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "42722",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1453279",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "259384",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01606320",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "0E640",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM",
            "identifier": "P1035782",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM",
            "identifier": "P971547",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIMENSION HEALTH",
            "identifier": "4386",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5682670",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.