Individual provider Active NPI

Angela Mitchell, MD

  • Internal Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1942462809
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME 124135 Issued in FL
Practice address
820 Prudential Dr Ste 304
Jacksonville, FL 32207-8205
Phone
(904) 346-3649
Fax
(904) 348-5627
NPI assigned
Jul 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X BP20035777 TX
Hospitalist Physician 208M00000X BP20035777 TX
Internal Medicine Physician 207R00000X ME 124135 FL Primary
Internal Medicine Physician 207R00000X N8424 TX

Addresses

Primary practice location

820 Prudential Dr Ste 304
Jacksonville, FL 32207-8205

Mailing address

PO Box 44004
Jacksonville, FL 32231-4004
Phone (904) 202-1032

Other identifiers 1

IdentifierTypeStateIssuer
014964900MedicaidFL

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

LicenseStateTypeSpecialty
ME 124135FLMDInternal Medicine Physician
BP20035777TXMDInternal Medicine Physician
N8424TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Primary Care Inc Internal Medicine 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.

NPI Registry JSON

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1942462809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44004",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314004",
            "telephone_number": "904-202-1032",
            "fax_number": "904-348-5627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 PRUDENTIAL DR STE 304",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078205",
            "telephone_number": "904-346-3649",
            "fax_number": "904-348-5627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "ANGELA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "BP20035777",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "BP20035777",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME 124135",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N8424",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014964900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.