Kevin Micael Mitcham, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

TC110 Issued in KY

Practice address

740 S Limestone Ste L119
Lexington, KY 40536-1239

Phone

(859) 257-3253

Fax

(859) 323-1203

NPI assigned

Jul 9, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN, VA, WY, KY, NY, WI, NC7 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 7

Specialty

Physician Assistant

Education

Mercer University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

United Medical Associates PCGroup PAC ID 0345144978, 229 clinicians

Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health St Mary's Hospital - Madison Hospital, Madison, WI, CCN 520083

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmitcham554672@direct-ehr-ssmhc.com

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.

• Dean Health Systems, Inc

  dba SSM Health Dean Medical Group

  • Allergy & Immunology Physician
  • Madison, WI
  • NPI 1053358846
  Medicare reassignment Care Compare group NPD
• United Medical Associates PC

  • Clinic/Center
  • Binghamton, NY
  • NPI 1013972801
  Medicare reassignment Care Compare group NPD
• University of Kentucky

  • Diagnostic Radiology Physician
  • Lexington, KY
  • NPI 1770771974
  Medicare reassignment NPD
• App of Tennessee Ed, PLLC

  • Emergency Medicine Physician
  • Maryville, TN
  • NPI 1003230236
  Medicare reassignment
• Banner Health Physicians West LLC

  • Multi-Specialty Clinic/Center
  • Casper, WY
  • NPI 1063778728
  Medicare reassignment
• Brunswick Physician Partners, PLLC

  • Emergency Medicine Physician
  • Bolivia, NC
  • NPI 1457822264
  Medicare reassignment
• Kernersville Emergency Group, PLLC

  • Emergency Medicine Physician
  • Kernersville, NC
  • NPI 1750852034
  Medicare reassignment
• Piedmont Triad Physicians, PLLC

  • Emergency Medicine Physician
  • Thomasville, NC
  • NPI 1295206464
  Medicare reassignment
• Tanglewood Park Physicians, PLLC

  • Emergency Medicine Physician
  • Clemmons, NC
  • NPI 1093286379
  Medicare reassignment
• Tri-Cities Regional Emergency Physicians, PC

  • Emergency Medicine Physician
  • Johnson City, TN
  • NPI 1063950046
  Medicare reassignment
• Urgent Specialty Associates PLLC

  • Surgery Physician
  • Richmond, VA
  • NPI 1487164604
  Medicare reassignment
• Western Virginia Regional Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Norton, VA
  • NPI 1386183028
  Medicare reassignment

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

• SSM Health Care of Wisconsin, Inc.

  dba SSM Health St. Mary's Hospital-Madison

  • General Acute Care Hospital
  • Madison, WI
  • NPI 1184621211
  Care Compare affiliation

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

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1740663608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 S LIMESTONE STE L119",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405361239",
            "telephone_number": "859-257-3253",
            "fax_number": "859-323-1203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021239",
            "country_code": "US",
            "telephone_number": "317-962-0582",
            "fax_number": "317-962-2082",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 W Stone Dr",
            "address_2": "Suite 310",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376606027",
            "country_code": "US",
            "telephone_number": "423-408-7050",
            "fax_number": "423-408-7054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHAM",
        "first_name": "KEVIN",
        "middle_name": "MICAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-09",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "TC110",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "2796",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC110",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2796",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10003888A",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "TC110",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "2796",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "233690173",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300070423",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmitcham@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1701 N Senate Blvd",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Saira Mirza, PHARMD
• Blaine Thomas Mischen, M.D.
• Filmon Misgina, M.S.
• Mission Lexington, Inc.
• Naoki Misumida, M.D.
• Madalyn Mitcham, MD
• Alicia Mitchell, MSOT
• Arianna Victoria,Merced,Knuf Mitchell, LPCC
• Bonnie Mitchell, MD
• Carol Mitchell, MD

• Physician Assistant in Lexington, KY
• Providers in Lexington, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; 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.