Srobona Mitra, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00049380 Issued in WA

Practice address

1806 W Lincoln Ave
Yakima, WA 98902-2473

Phone

(509) 452-4520

Fax

(509) 452-5224

NPI assigned

Mar 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

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.

• Interlake Medical Center, PLLC

  • Family Medicine Physician
  • Redmond, WA
  • NPI 1619998978
  Medicare reassignment NPD

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236556800000",
    "number": "1770601353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18625 NE 139TH ST",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980726586",
            "telephone_number": "206-849-7273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 W LINCOLN AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989022473",
            "telephone_number": "509-452-4520",
            "fax_number": "509-452-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRA",
        "first_name": "SROBONA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2009-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WA",
            "license": "ML20007916",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00049380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rishi S Mistry, ARNP
• Gregory Mitchell, MSW, MHP
• Jessica Rose Mitchell
• Lena Mitchell
• Sheila Marie Mitchell, MD
• Charlene K. Mize, MS, RDN, CD
• Judy Mobley
• Palash Modi, DDS
• Brianna Moen, QMHA
• Madeline Moen

• Family Medicine Physician in Yakima, WA
• Providers in Yakima, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; 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.