Sandra Lee Mitkos, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2009036279 Issued in MO

Practice address

108 Frizzell St
Potosi, MO 63664-1505

Phone

(573) 438-5408

Fax

(573) 438-2419

NPI assigned

Dec 29, 2009

Last updated

Apr 25, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Washington County Memorial HospitalGroup PAC ID 3476456880, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Washington County Memorial Hospital Hospital, Potosi, MO, CCN 261308

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sandra.mitkos.p1@direct.wcmh-clinics.nextgenshare.com

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.

• Washington County Memorial Hospital

  • Critical Access Hospital
  • Potosi, MO
  • NPI 1194838821
  Medicare reassignment Care Compare group NPD
• Potosi Emergency Group, LLC

  • Emergency Medicine Physician
  • Potosi, MO
  • NPI 1881075349
  Medicare reassignment NPD
• Washington County Memorial Hospital

  dba Belgrade Rural Health Clinic

  • Rural Health Clinic/Center
  • Belgrade, MO
  • NPI 1871102137
  NPD
• Midwest Health Group Convenient Care

  • Family Medicine Physician
  • Farmington, MO
  • NPI 1578797031
  NPD (past)
• Midwest Health Group Convenient Care, LLC

  dba Midwest Convenient Care

  • Non-Pharmacy Dispensing Site
  • Fredericktown, MO
  • NPI 1861948697
  NPD (past)
• Washington County Memorial Hospital

  dba Austin Plaza Primary Care Clinic

  • Rural Health Clinic/Center
  • Potosi, MO
  • NPI 1467424788
  NPD (past)

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

• Washington County Memorial Hospital

  • Critical Access Hospital
  • Potosi, MO
  • NPI 1194838821
  Care Compare affiliation

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

{
    "created_epoch": "1262044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524614400000",
    "number": "1790015527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HEALTH WAY DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641420",
            "telephone_number": "573-438-5451",
            "fax_number": "573-438-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 FRIZZELL ST",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641505",
            "telephone_number": "573-438-5408",
            "fax_number": "573-438-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITKOS",
        "first_name": "SANDRA",
        "middle_name": "LEE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-29",
        "last_updated": "2018-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2009036279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Midwest Health Solutions LLC (Midwest Rural Convenient Care)
• Midwest Health Solutions LLC (Midwest Rural Convenient Care)
• Midwest Imaging Center II, LLC
• Nicole Minx, LMT
• Carrie Jane Missey, L.M.T
• Alex Morgan
• Neal Neuman, MD
• Stacy Nichols, COTA/L
• Nikodem and Hill Family Dental and Ortho
• Deirdre L Nivens, FAMILY NURSE PRACITI

• Family Nurse Practitioner in Potosi, MO
• Providers in Potosi, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; 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.