Bryan Michael Mistretta, DO

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

036174964 Issued in IL

Practice address

315 W Carpenter St
Springfield, IL 62702-4901

Phone

(217) 545-8000

Fax

(217) 545-0952

NPI assigned

May 25, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

General Surgery

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1590364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1932722006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19638",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W CARPENTER ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024901",
            "telephone_number": "217-545-8000",
            "fax_number": "217-545-0952"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St Ste D327",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627023757",
            "country_code": "US",
            "telephone_number": "217-545-8444",
            "fax_number": "217-545-7762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MISTRETTA",
        "first_name": "BRYAN",
        "middle_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-25",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "IL",
            "license": "036174964",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125076122",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dureali Mirjat
• Nichole Mirocha, D.O.
• Mirrors Inc
• Missouri Dental Professionals, Richard Straus, DMD, PC (Distinctive Dental Solutions)
• Venkata R Karthik Missula, MD
• Jessica N Mistretta, DO
• Brittany R. Mitchell, LMT
• Cheryl Mitchell
• James Allen Mitchell, CRNA
• Jessica Christine Mitchell, PA-C

• Colon & Rectal Surgery Physician in Springfield, IL
• Providers in Springfield, IL by specialty
• Colon & Rectal Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.