Michael M Dutkevicz, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1809 Issued in WV

Practice address

135 Professional PL
Bridgeport, WV 26330-4509

Phone

(681) 342-3680

Fax

(681) 342-3665

NPI assigned

Jun 30, 2005

Last updated

May 20, 2015By the provider in NPPES

Sex

Male

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

Medicare fee-for-service enrollment

Enrolled in WV

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

Practice roles

Locations

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.

• United Hospital Center, Inc.

  • Internal Medicine Physician
  • Bridgeport, WV
  • NPI 1760965586
  Medicare reassignment NPD

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432080000000",
    "number": "1902803331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 PROFESSIONAL PL",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263304509",
            "telephone_number": "681-342-3680",
            "fax_number": "681-342-3665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 PROFESSIONAL PL",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263304509",
            "telephone_number": "681-342-3680",
            "fax_number": "681-342-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTKEVICZ",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2015-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "1809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0070754",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dr. Kress Eyecare Associates, PLLC
• Elijah Bradley Drummond, PA-C
• Sophia Tina Nicole Duarte
• James Arthur Dunbar III, MSW; PH.D.
• Rachel Lydia Dunn, LGSW
• Jason Dziak, MS OTR/L
• Heather J Earl, PAC
• Cheyenne Earle, DO
• Holly Virginia Echard
• Rachel Eddy, APRN, FNP-C

• Physician Assistant in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.