Mitchell Bryan Booth, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

DP224114 Issued in OR

Practice address

1904 E Barnett Rd
Medford, OR 97504-8262

Phone

(541) 776-3338

Fax

(541) 776-4979

NPI assigned

Mar 22, 2022

Last updated

Jun 2, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Oregon Foot and Ankle LLCGroup PAC ID 3274628359, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Medford Medical Center Hospital, Medford, OR, CCN 380075
• Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mitchell.booth@hca3.eclinicaldirectplus.com

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.

• Southern Oregon Foot & Ankle, LLC

  • Foot Surgery Podiatrist
  • Medford, OR
  • NPI 1891980546

  Foot & Ankle Surgery

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Asante

  dba Asante Rogue Regional Medical Center

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1770587107
  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence Medford Medical Center

  • General Acute Care Hospital
  • Medford, OR
  • NPI 1689755670
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1659020949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2307 W JOYLI CIR",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840887652",
            "telephone_number": "385-228-6548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1904 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048262",
            "telephone_number": "541-776-3338",
            "fax_number": "541-776-4979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "MITCHELL",
        "middle_name": "BRYAN",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-22",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP224114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Bonsi
• Stephanie Roseanna Booker, LMT
• Amy S Boone, L.M.T., C.E.I.M.
• Monica Boone
• James Booth, MD
• Tiana Boozer, CADC-R
• Alysse Lynette Borba, CRMII, PSS, CRGM
• Anne Meredith Bordelon
• Hal L Borg, DMD
• Kristin Marie Borg

• Foot & Ankle Surgery Podiatrist in Medford, OR
• Providers in Medford, OR by specialty
• Foot & Ankle Surgery Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; 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.

Verify at the official NPI Registry.