Active NPI
Jeffrey L Mikutis, DO
- Pediatric Orthopaedic Surgery Physician
- Dayton, OH
National Provider Identifier
1720028863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Orthopaedic Surgery Physician
- License
- 34.005638
- Practice address
- 1 Childrens PLZ
Dayton, OH 45404-1815 - Phone
- (937) 641-4000
- Fax
- (937) 641-4500
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Orthopaedic Surgery Physician | 207XP3100X | 34.005638 | OH | Primary |
Addresses
Primary practice location
1 Childrens PLZ
Dayton, OH 45404-1815
Mailing address
1 Childrens PLZ
Dayton, OH 45404-1815
Phone (937) 641-3000
Other practice location 1
865 W Market St
Troy, OH 45373-3837
Phone (937) 641-4000
Other practice location 2
3333 W Tech Rd
Miamisburg, OH 45342-0955
Phone (937) 641-4000
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05279 | Other | OH | PARAMOUNT |
| 200533320 | Medicaid | IN | |
| 0917664 | Medicaid | OH | |
| 326196 | Other | OH | ONE NATION |
| 64117427 | Medicaid | KY | |
| 0917664 | Other | OH | BCMH |
| 200567 | Other | OH | UNISON |
| 4329917 | Other | OH | AETNA |
| 311676182027 | Other | OH | CARESOURCE |
| 326196 | Other | OH | BC/BS |
| 738694 | Other | OH | BUCKEYE |
| 278476 | Other | OH | AMERIGROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34.005638 | OH | MD | Pediatric Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Interoperability endpoints
- jeffrey.mikutis.1@29318.direct.athenahealth.com
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634601600000",
"number": "1720028863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CHILDRENS PLZ",
"city": "DAYTON",
"state": "OH",
"postal_code": "454041815",
"telephone_number": "937-641-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CHILDRENS PLZ",
"city": "DAYTON",
"state": "OH",
"postal_code": "454041815",
"telephone_number": "937-641-4000",
"fax_number": "937-641-4500"
}
],
"practiceLocations": [
{
"address_1": "865 W Market St",
"address_purpose": "LOCATION",
"city": "Troy",
"state": "OH",
"postal_code": "453733837",
"country_code": "US",
"telephone_number": "937-641-4000",
"fax_number": "937-641-4500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3333 W Tech Rd",
"address_purpose": "LOCATION",
"city": "Miamisburg",
"state": "OH",
"postal_code": "453420955",
"country_code": "US",
"telephone_number": "937-641-4000",
"fax_number": "937-641-4500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIKUTIS",
"first_name": "JEFFREY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2021-10-19",
"certification_date": "2021-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207XP3100X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
"state": "OH",
"license": "34.005638",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "05279",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200533320",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0917664",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE NATION",
"identifier": "326196",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64117427",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCMH",
"identifier": "0917664",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISON",
"identifier": "200567",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4329917",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "311676182027",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "326196",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUCKEYE",
"identifier": "738694",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "278476",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.