Mitchell Dongjun Imm, M.D.

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

200200707 Issued in NC

Practice address

10647 Bramblecrest Dr
Austin, TX 78726-1906

Phone

(512) 906-1974

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

No

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.

• Pediatrix Medical Group of Texas Billing, Inc.

  • Neonatal-Perinatal Medicine Physician
  • Houston, TX
  • NPI 1649377359

  Pediatrics, TX

  Medicare reassignment NPD
• Ascension Seton

  • General Acute Care Hospital
  • Austin, TX
  • NPI 1124137054
  NPD (past)
• Ascension Seton

  • General Acute Care Hospital
  • Austin, TX
  • NPI 1164526786
  NPD (past)
• Ascension Seton

  • General Acute Care Hospital
  • Round Rock, TX
  • NPI 1578780870
  NPD (past)
• Ascension Seton

  • General Acute Care Hospital
  • Kyle, TX
  • NPI 1619115383
  NPD (past)
• Cedar Park Health System LLC

  • General Acute Care Hospital
  • Cedar Park, TX
  • NPI 1376662296
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in TX

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

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 2, 2008.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220313600000",
    "number": "1790731230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10647 BRAMBLECREST DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787261906",
            "telephone_number": "512-906-1974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10647 BRAMBLECREST DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787261906",
            "telephone_number": "512-906-1974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMM",
        "first_name": "MITCHELL",
        "middle_name": "DONGJUN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2008-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "200200707",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NC",
            "license": "200200707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89131UT",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "131UT",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7355461",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "D8866",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Imagine Art
• Imaging Partners of Austin LLC
• Imaging Partners of Austin LLC
• Erin Imeson, NP
• Shelley L Imholte, PHD
• Ladonna L Immken, MD
• Elizabeth Imouokhome
• Impact Lives LLC
• Impairment Solutions
• Arthur Patrick Imperial, D.D.S., P.C

• All providers in Austin, TX
• Neonatal-Perinatal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; 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.