Individual provider Active NPI

Tyler John Mitchell, MD

  • Internal Medicine Physician
  • Coronado, CA
National Provider Identifier
1831718931
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A183673 Issued in CA
Practice address
908 J Ave
Coronado, CA 92118-2417
Phone
(619) 846-6440
NPI assigned
Apr 9, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X A183673 CA Primary

Addresses

Primary practice location

908 J Ave
Coronado, CA 92118-2417

Mailing address

39000 Bob Hope Dr
Rancho Mirage, CA 92270-3221
Phone (760) 333-1813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20230406000336 CA Practitioner - Internal Medicine 1557736428 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Diego Critical Care Medical Group IncGroup PAC ID 7911083886, 74 clinicians
Emergency and Acute Care Medical CorporationGroup PAC ID 9537108279, 431 clinicians

Practice addresses (Care Compare)

5555 Grossmont Ctr Dr
La Mesa, CA 91942-3019
Phone (619) 461-1920

Hospital & facility affiliations

  • Sharp Coronado Hospital and Hlthcr Ctr Hospital, Coronado, CA, CCN 050234
  • Sharp Memorial Hospital Hospital, San Diego, CA, CCN 050100
  • Scripps Mercy Hospital Hospital, San Diego, CA, CCN 050077

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A183673CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency and Acute Care Medical Corporation CurrentSince Sep 1, 2023 Accepting new patients
San Diego Critical Care Medical Group, Inc Internal Medicine CurrentSince Apr 1, 2023 Accepting new patients

Locations

5555 Grossmont Center Dr
La Mesa, CA 91942
Phone (619) 465-0711

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

250 Prospect Pl
San Diego, CA 92118
Phone (619) 522-3600

Organizations & group practices 2

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 4

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": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1831718931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-333-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 J AVE",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921182417",
            "telephone_number": "619-846-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "TYLER",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-09",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A183673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coronado, CA

Sources for this page

Verify at the official NPI Registry.