NPIMap

Organization Active NPI

Mittie M Dragosljvich MD LLC

  • Specialist
  • Branson, MO
National Provider Identifier
1790072205
Registry record updated Jul 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
2008011533 Issued in MO
Legal business name
MITTIE M DRAGOSLJVICH MD LLC
Practice address
545 Branson Landing Blvd Ste 101
Branson, MO 65616-4055
Phone
(417) 348-8032
NPI assigned
Jul 5, 2011
Last updated
Jul 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2011

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

Authorized official

Name
Dr. Mittie Matthew Dragosljvich, M.D.NPI 1851408934
Title
Physician/Manager
Phone
(580) 917-5392

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 2008011533 MO Primary

Addresses

Primary practice location

545 Branson Landing Blvd Ste 101
Branson, MO 65616-4055

Mailing address

PO Box 1071
Branson, MO 65615-1071
Phone (580) 917-5392

Other identifiers 2

IdentifierTypeStateIssuer
100025090AMedicaidOK
731377294001OtherOKBC/BS OF OKLAHOMA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1309824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1790072205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1071",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656151071",
            "telephone_number": "580-917-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 BRANSON LANDING BLVD STE 101",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656164055",
            "telephone_number": "417-348-8032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITTIE M DRAGOSLJVICH MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-05",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "DRAGOSLJVICH",
        "authorized_official_first_name": "MITTIE",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PHYSICIAN/MANAGER",
        "authorized_official_telephone_number": "580-917-5392",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MO",
            "license": "2008011533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100025090A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF OKLAHOMA",
            "identifier": "731377294001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Branson, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.