NPIMap

Individual provider Active NPI

Amitabha Mitra, MD

  • Plastic and Reconstructive Surgery Physician
  • Williamsport, PA
National Provider Identifier
1831187871
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
MD023302E Issued in PA
Practice address
1100 Grampian Blvd
Williamsport, PA 17701-1907
Phone
(570) 326-8005
NPI assigned
Oct 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X MD023302E PA Primary

Addresses

Primary practice location

1100 Grampian Blvd
Williamsport, PA 17701-1907

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amitabha.mitra@upmcdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040205000872 PA Practitioner - Plastic and Reconstructive Surgery 4688570682 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 1968
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Susquehanna Physician ServicesGroup PAC ID 2264336460, 611 clinicians
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

1100 Grampian Blvd
Williamsport, PA 17701-1909
Phone (570) 326-8005

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

  • Upmc Williamsport Hospital, Williamsport, PA, CCN 390045

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision16
Removal of tissue1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD023302EPAMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Conemaugh Physician Practices LLC CurrentSince Jul 1, 2016 Accepting new patients
DLP Conemaugh Physician Practices LLC CurrentSince Jul 1, 2016 Accepting new patients
Susquehanna Physician Services Plastic and Reconstructive Surgery CurrentSince Oct 1, 2018 Accepting new patients
DLP Conemaugh Physician Practices LLC Current Accepting new patients
Susquehanna Physician Services CurrentSince Oct 1, 2018 Accepting new patients
SCHC Pediatric Associates, LLC Past Accepting new patients
Susquehanna Physician Services Past Accepting new patients
Apple Drugs Inc Past Accepting new patients

Locations

1 Tech Park Dr
Ste 1200
Johnstown, PA 15901
Phone (814) 534-6750

1111 Franklin St
Ste 180
Johnstown, PA 15905
Phone (814) 534-3740

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

1100 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8005

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

700 High St
Williamsport, PA 17701
Phone (570) 321-1000

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • Direct secure messaging: amitra177056@upmc.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1831187871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011907",
            "telephone_number": "570-326-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRA",
        "first_name": "AMITABHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "PA",
            "license": "MD023302E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amitabha.mitra@upmcdirect.com",
            "affiliation": "N",
            "endpointDescription": "secure UPMC direct address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "600 Grant St Fl 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.