Active NPI
Scott Bradley Mutchler, MD
- Pediatric Critical Care Medicine Physician
- Fargo, ND
National Provider Identifier
1942236419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 5699
- Practice address
- 3000 32ND Ave S
Fargo, ND 58103-6132 - Phone
- (701) 364-8000
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 5699 | ND | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | 5699 | ND | Primary |
Addresses
Primary practice location
3000 32ND Ave S
Fargo, ND 58103-6132
Mailing address
400 East Third Street
McL2Cred
Duluth, MN 55805-1951
Phone (218) 786-1183
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 269757200 | Medicaid | FL | |
| 202065421 | Medicaid | MO |
Other names 1
- Scott Bradley Mutchler
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5699 | ND | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Curators of the University of Missouri | 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.
-
- Community/Retail Pharmacy
- Jefferson City, MO
- NPI 1740083641
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539216000000",
"number": "1942236419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 EAST THIRD STREET",
"address_2": "MCL2CRED",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-786-1183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 32ND AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036132",
"telephone_number": "701-364-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTCHLER",
"first_name": "SCOTT",
"middle_name": "BRADLEY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2018-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "ND",
"license": "5699",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "ND",
"license": "5699",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "269757200",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202065421",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SCOTT",
"last_name": "MUTCHLER",
"middle_name": "BRADLEY",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.