Rebecca Lynn Mittelstadt, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA405 Issued in AL

Practice address

2709 Legends Pkwy
Prattville, AL 36066-7755

Phone

(334) 310-1117

NPI assigned

Mar 3, 2006

Last updated

Sep 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rebecca.mittelstadt.1@9954.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cahaba Valley Surgical Group, PC

  • Surgery Physician
  • Alabaster, AL
  • NPI 1902902398
  Medicare reassignment
• Gastroenterology Associates of North-Central Alabama Inc

  • Specialist
  • Birmingham, AL
  • NPI 1528080595
  Medicare reassignment
• Gastroenterology Associates of North-Central Alabama Inc

  dba Southeast Gastro

  • Anesthesiology Physician
  • Birmingham, AL
  • NPI 1912446105
  NPD

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1841267226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2709 LEGENDS PKWY",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360667755",
            "telephone_number": "334-310-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2709 LEGENDS PKWY",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360667755",
            "telephone_number": "334-310-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTELSTADT",
        "first_name": "REBECCA",
        "middle_name": "LYNN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-03",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AL",
            "license": "PA405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "51000413",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rebecca.mittelstadt.1@9954.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "2709 Legends Pkwy",
            "city": "Prattville",
            "state": "AL",
            "country_code": "US",
            "postal_code": "360667755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Surgical Physician Assistant in Prattville, AL
• Providers in Prattville, AL by specialty
• Surgical Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.