Larry David Mitnaul Jr., M.D., M.P.H., M.S.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

04-40194 Issued in KS

Practice address

1515 S Clifton Ave Ste 300
Wichita, KS 67218-2953

Phone

(316) 858-0550

Fax

(316) 858-0596

NPI assigned

Jun 14, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

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

Specialty

Psychiatry

Education

University of Texas Medical School at San Antonio, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ascension Medical Group Via Christi PAGroup PAC ID 2961314497, 184 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science

State licenses

Practice roles

Locations

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.

• Ascension Medical Group Via Christi, PA

  • Multi-Specialty Clinic/Center
  • Wichita, KS
  • NPI 1063453991
  Medicare reassignment Care Compare group NPD
• Ascension Medical Group Via Christi, PA

  • Rural Health Clinic/Center
  • Wellington, KS
  • NPI 1538773569
  NPD

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1659633709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 S CLIFTON AVE STE 300",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672182953",
            "telephone_number": "316-858-0550",
            "fax_number": "316-858-0596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 S CLIFTON AVE STE 300",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672182953",
            "telephone_number": "316-858-0550",
            "fax_number": "316-858-0596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITNAUL",
        "first_name": "LARRY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D., M.P.H., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-14",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KS",
            "license": "04-40194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystal Mitchell, APRN
• Laila Mitchell
• Lauren Mitchell
• Lindsey J Mitchell, PA-C
• Shane Mitchell Sr.
• Natalie Mizell, M.S. CCC-SLP
• MJM Kansas Internal Medicine, P.a.
• MKC Counseling, LLC
• Mobile Doctors of Kansas
• Mobile Medical II, LLC

• Child & Adolescent Psychiatry Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Child & Adolescent Psychiatry Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.