Jeffrey Jerome Mitchell, NP
Individual provider Active NPI Family Nurse Practitioner · Richton, MS
NPI 1942234232 · NPPES record last updated Nov 10, 2010
Key facts
- NPI
- 1942234232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R832748 (MS)
- Practice address
- 206 Bay Ave
Richton, MS 39476-2941 - Phone
- (601) 788-6316
- Fax
- (601) 788-6316
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Covington County Hospital
Practice addresses (Care Compare)
347 Magnolia Dr
Raleigh, MS 39153-6011
Phone (601) 374-9070
603 S Main St
Green Tree Family Medical Clinic
Mt Olive, MS 39119-8902
Phone (601) 797-3405
701 S Holly Ave
Collins, MS 39428-3894
Phone (601) 765-6711
Hospital & facility affiliations
- Covington County Hospital Cah
- Simpson General Hospital Cah
- Smith County Emergency Hospital
- South Central Reg Med Ctr
- Jasper General Hospital
- Covington County Hospital Cah
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050124000631 | MS | Practitioner - Nurse Practitioner | 1557311032 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R832748 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Green Tree Family Medical Clinic | Current | Accepting new patients | |
| Covington County Hospital | Current | Accepting new patients | |
| South Mississippi Health Service, Inc | Family | Past | Accepting new patients |
Locations
3275 Highway 49
Ste E
Collins, MS 39428
Phone (601) 765-6292
701 S Holly Ave
Collins, MS 39428
Phone (601) 765-3180
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R832748 | MS | Yes |
Addresses
Primary practice location
206 Bay Ave
Richton, MS 39476-2941
Mailing address
229 Oral Church Rd
Sumrall, MS 39482-4015
Phone (601) 264-3448
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0122793 | Medicaid | MS |
Other providers in Richton, MS
- Marley McCardle
- Nicole McCardle
- Jerryl McGowan-Craft
- Mary McSwain
- Jennifer Leigh Mills
- Brenda Joyce Nicholson
- Victoria Rachelle Owens
- Pace Medical Clinic, LLC
- James Michael Pace
- Par Medical Inc
All providers in Richton, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.