Prodyot Kumar Mitra, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036052608 Issued in IL

Practice address

633 Ridgeview Drive
McHenry, IL 60050-7012

Phone

(815) 344-0621

Fax

(815) 344-0664

NPI assigned

Nov 27, 2006

Last updated

May 8, 2008By 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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sanjukta Mitra, MD

  • Internal Medicine Physician
  • McHenry, IL
  • NPI 1255407805
  Medicare reassignment

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.

• Prodyot K. Mitra, M.D.

  • Surgery Physician
  • McHenry, IL
  • NPI 1477724425
  NPD (past) Authorized official
• Omso Medical LTD

  • Internal Medicine Physician
  • McHenry, IL
  • NPI 1104948991
  NPD (past)

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210204800000",
    "number": "1699841247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 RIDGEVIEW DRIVE",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507012",
            "telephone_number": "815-344-0621",
            "fax_number": "815-344-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 RIDGEVIEW DRIVE",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507012",
            "telephone_number": "815-344-0621",
            "fax_number": "815-344-0664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRA",
        "first_name": "PRODYOT",
        "middle_name": "KUMAR",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2008-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036052608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05600205",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "024000852",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360526081",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5432896",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Michele Misnik
• Antonio Tajuan Mister, M.D.
• Deborah A Mitchell, PT, DPT, MPT
• Virginia Mitchell
• Deepak Mitra, MD
• Sanjukta Mitra, MD
• Kelsey Ann Mix, PT, DPT, MS,CMTPT/DN
• Michael Mlynski, O.D.
• Lee Gregory Mohr
• Yuriy O Moklyak, M.D.

• Surgery Physician in McHenry, IL
• Providers in McHenry, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; 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.