Michael Mitry, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

2384 Issued in MA

Practice address

1410 Highland Ave Ste 204
Needham, MA 02492-4460

Phone

(781) 444-4044

Fax

(781) 444-5044

NPI assigned

Sep 2, 2010

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 1

Medicare fee-for-service enrollment

Enrolled in MA

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

New York College of Podiatric Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shenouda CorpGroup PAC ID 7113236399, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• South Shore Hospital Hospital, South Weymouth, MA, CCN 220100
• Beth Israel Deaconess Hospital - Needham Hospital, Needham, MA, CCN 220083
• Brigham and Women'S Hospital Hospital, Boston, MA, CCN 220110

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Shenouda Corp

  • Foot & Ankle Surgery Podiatrist
  • Needham, MA
  • NPI 1386036275
  Medicare reassignment Care Compare group NPD Authorized official

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

• Brigham & Womens Hospital, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1790717650
  Care Compare affiliation
• South Shore Hospital Inc.

  • General Acute Care Hospital
  • South Weymouth, MA
  • NPI 1134227606
  Care Compare affiliation

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

{
    "created_epoch": "1283385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1700193406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 HIGHLAND AVE",
            "address_2": "STE 204",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024922617",
            "telephone_number": "781-444-4044",
            "fax_number": "781-444-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 HIGHLAND AVE STE 204",
            "city": "NEEDHAM",
            "state": "MA",
            "postal_code": "024924460",
            "telephone_number": "781-444-4044",
            "fax_number": "781-444-5044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 East St Ste 6",
            "address_purpose": "LOCATION",
            "city": "Hanover",
            "state": "MA",
            "postal_code": "023394460",
            "country_code": "US",
            "telephone_number": "781-826-1150",
            "fax_number": "781-826-6052",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "95 Chapel St Ste 3C",
            "address_purpose": "LOCATION",
            "city": "Norwood",
            "state": "MA",
            "postal_code": "020623161",
            "country_code": "US",
            "telephone_number": "781-762-5155",
            "fax_number": "781-444-5044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITRY",
        "first_name": "MICHAEL",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-02",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MA",
            "license": "2384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110103207A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert David Mintz, PH.D., LMHC
• Grace Mirabile
• Selma Zelda Mirsky, L.I.C.S.W.
• Megan R Mistry, DO
• Clare Eileen Mitchell
• Ronald Molin, PH.D.
• Samuel Monius, BA
• Erin Patricia Moore, BCBA
• Gerald Moran
• Charles L. Morrison

• Foot & Ankle Surgery Podiatrist in Needham, MA
• Providers in Needham, MA by specialty
• Foot & Ankle Surgery Podiatrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.