Active NPI
Katherine Montague Mizelle, MD
- Pediatric Cardiology Physician
- Columbus, OH
National Provider Identifier
1881688893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 35078529
- Practice address
- 700 Children'S Drive
Columbus, OH 43205-2664 - Phone
- (614) 722-3100
- Fax
- (614) 722-2549
- NPI assigned
- Sep 6, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 35078529 | OH | Primary |
| Pediatric Critical Care Medicine Physician | 2080P0203X | 35078529 | OH |
Addresses
Primary practice location
700 Children'S Drive
Columbus, OH 43205-2664
Mailing address
700 Children'S Drive
Columbus, OH 43205-2664
Phone (614) 722-3100
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1802977000 | Medicaid | WV | |
| 64027246 | Medicaid | KY | |
| MI4040601 | Other | OH | MEDICARE |
| MI4040602 | Other | OH | MEDICARE |
| 2211403 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453334400000",
"number": "1881688893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 CHILDREN'S DRIVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432052664",
"telephone_number": "614-722-3100",
"fax_number": "614-722-2549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 CHILDREN'S DRIVE",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432052664",
"telephone_number": "614-722-3100",
"fax_number": "614-722-2549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIZELLE",
"first_name": "KATHERINE",
"middle_name": "MONTAGUE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-06",
"last_updated": "2016-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "OH",
"license": "35078529",
"primary": true
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "OH",
"license": "35078529",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1802977000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64027246",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "MI4040601",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "MI4040602",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2211403",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.