Krystal Mitchell, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A180532 Issued in CA

Practice address

433 N Camden Dr
Beverly Hills, CA 90210-4409

Phone

(105) 507-6613

NPI assigned

Mar 29, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Krystal Mitchell-Gba Former name

Medicare fee-for-service enrollment

Enrolled in NY, CA2 enrollments

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 2

Specialty

Dermatology

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Life Wound Clinic a Professional Nursing CorporationGroup PAC ID 9436419017, 7 clinicians

Premier Medical Group of the Hudson Valley PCGroup PAC ID 3072575109, 134 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rochester General Hospital Hospital, Rochester, NY, CCN 330125

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: kmitchell@premiermedicalhv.medentdirect.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.

• Active Life Wound Clinic a Professional Nursing Corporation

  • Nurse Practitioner
  • Sacramento, CA
  • NPI 1801253323
  Medicare reassignment Care Compare group NPD
• Premier Medical Group of the Hudson Valley P.C.

  • Urology Physician
  • Poughkeepsie, NY
  • NPI 1255437166

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Active Life Wound Center a Professional Medical Corporation

  • Family Medicine Physician
  • Sacramento, CA
  • NPI 1396553616

  Dermatology

  Medicare reassignment NPD
• Doral Medical and Multi Specialty Facility LLC

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1144693607
  Medicare reassignment
• Premier Medical Group of the Hudson Valley, P.C.

  • Podiatrist
  • Wappingers Falls, NY
  • NPI 1467290130
  NPD
• Bethany Medical Clinic of New York, PLLC

  • Internal Medicine Physician
  • New York, NY
  • NPI 1902173313
  NPD (past)

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

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1801391040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 N SOONER RD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731419518",
            "telephone_number": "405-250-6891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 N CAMDEN DR",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902104409",
            "telephone_number": "105-507-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KRYSTAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-29",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NY",
            "license": "326417",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "1801391040",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A180532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "MITCHELL-GBA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shiva Mishaeel
• Mission Addiction Treatment, LLC
• Mission Care Medical, Inc.
• Danielle Missler, MFT
• Joanna Missry, MCSW,CDP,MSW,MHP
• Danielle Cara Mitock, LMFT
• Joel D Mittleman, M.D.,
• Michael Tetsuya Miyazaki, D.O.
• Parvaz Farnad Mizrahi, D.D.S.
• Sanam Farokhi Mizrahi, PHARM D

• Dermatology Physician in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.