Mark Edward Mitchell, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2681761205 Issued in UT

Practice address

2960 Tongass Avenue
Ketchikan, AK 99901-5742

Phone

(907) 228-4900

Fax

(800) 852-3264

NPI assigned

Mar 24, 2006

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TX, NV2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Affordable Emergency Medicine Solutions LTD

  • Urgent Care Clinic/Center
  • Spring Creek, NV
  • NPI 1093239626
  Medicare reassignment NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Sallisaw, OK
  • NPI 1780692723

  TX

  Medicare reassignment NPD
• DHHS, PHS, Naihs, Shiprock Hospital

  • General Acute Care Hospital
  • Shiprock, NM
  • NPI 1780639971

  TX

  Medicare reassignment NPD
• Ketchikan Indian Corporation

  • Primary Care Clinic/Center
  • Ketchikan, AK
  • NPI 1821120486

  TX

  Medicare reassignment
• Cherokee Nation

  • Public Health or Welfare Agency
  • Tahlequah, OK
  • NPI 1013884154
  NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Salina, OK
  • NPI 1326054081
  NPD
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Muskogee, OK
  • NPI 1841207156
  NPD
• Premise Health of Nevada Medical Hinitt P C

  • Family Medicine Physician
  • Winnemucca, NV
  • NPI 1437185105
  NPD (past)
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1689634479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVENUE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-4900",
            "fax_number": "800-852-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVENUE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-4900",
            "fax_number": "800-852-3264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "2681761205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52588084",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82071365",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D0289",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "314804",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Lee Miller
• Abigayle Miner
• Roberta Ruth Minshall, RN
• Jason James Mitchell
• Lynnlee L Mitchell
• Rebecca Moon, LCSW
• Chelsea Morey
• Jason Connan Morin, CHA
• Chloe Morneau
• Jennifer Morneau

• Family Medicine Physician in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• Family Medicine Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.