Ivana Mitic, CRNA

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R212937 Issued in MD

Practice address

909 Ridgebrook Rd Ste 202
Sparks, MD 21152-9476

Phone

(410) 870-5482

NPI assigned

Mar 1, 2013

Sex

Female

Sole proprietor

Yes

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 MD2 enrollments

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 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifebridge Anesthesia Associates LLCGroup PAC ID 2062514888, 109 clinicians

Baltimore Ketamine ClinicGroup PAC ID 9739568569, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwest Hospital Center Hospital, Randallstown, MD, CCN 210040

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

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 and National Provider Directory roles.

• Baltimore Ketamine Clinic

  • Psychiatric/Mental Health Nurse Practitioner
  • Sparks Glencoe, MD
  • NPI 1972145381
  Medicare reassignment Care Compare group NPD Authorized official
• Lifebridge Anesthesia Associates, LLC

  • Anesthesiology Physician
  • Randallstown, MD
  • NPI 1003992868
  Medicare reassignment Care Compare group NPD
• Baltimore Ketamine Clinic

  • Infusion Therapy Clinic/Center
  • Sparks, MD
  • NPI 1508580275
  NPD Authorized official
• Marion Hospital Corporation

  dba Heartland Regional Medical Center

  • Anesthesiology Physician
  • Marion, IL
  • NPI 1356327282
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northwest Hospital Center, Inc.

  • General Acute Care Hospital
  • Randallstown, MD
  • NPI 1487695888
  Care Compare affiliation

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

{
    "created_epoch": "1362096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1962743815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 RIDGEBROOK RD STE 202",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 RIDGEBROOK RD STE 202",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529476",
            "telephone_number": "410-870-5482"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2324 N Zion Rd Ste 113",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218012576",
            "country_code": "US",
            "telephone_number": "410-870-5482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITIC",
        "first_name": "IVANA",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-01",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "784417",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R212937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jobria McDonald-Yates
• Nyjae McFarlane
• Jiavanna Medlock
• Medstar Medical Group II LLC
• Temma Meinecke, M.P.T.
• Kiara Mohamed
• Abigail Molofsky
• Amanda Moore
• Rubi Morales-Salinas
• Samantha Morgan

• Psychiatric/Mental Health Nurse Practitioner in Sparks, MD
• Providers in Sparks, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.