Individual provider Active NPI

Mira Maria John, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • La Jolla, CA
National Provider Identifier
1013448588
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
A196769 Issued in CA
Practice address
9300 Campus Point Dr
La Jolla, CA 92037-1300
Phone
(800) 926-8273
NPI assigned
Mar 25, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A196769 CA
Internal Medicine Physician 207R00000X MD61153632 WA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X MD61153632 WA
Pulmonary Disease Physician 207RP1001X A196769 CA
Hospitalist Physician 208M00000X 298729 NY
Critical Care Medicine (Internal Medicine) Physician 207RC0200X A196769 CA Primary

Addresses

Primary practice location

9300 Campus Point Dr
La Jolla, CA 92037-1300

Mailing address

File 57326
Los Angeles, CA 90074-7326
Phone (800) 926-8273

Other practice location 1

17 E 102nd St
New York, NY 10029-5204
Phone (212) 659-8551

Other practice location 2

550 1st Ave
New York, NY 10016-6402
Phone (212) 263-7300

Other practice location 3

1959 NE Pacific Street
Seattle, WA 98195
Phone (206) 616-8378

Other practice location 4

4011 Talbot Rd S Ste 460
Renton, WA 98055-5791
Phone (425) 690-3484

Other practice location 5

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (800) 926-8273

Other practice location 6

4520 Executive Dr
San Diego, CA 92121-3018
Phone (800) 926-8273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230620000825 WA Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 3971849613 Reassigns benefits to 1 organization
I20240816001054 CA Practitioner - Critical Care (Intensivists)Practitioner - Internal MedicinePractitioner - Pulmonary Disease 3971849613 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine, Pulmonary Disease
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 249-6753

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A196769CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Pulmonary Disease CurrentSince Jul 2, 2024 Accepting new patients
Valley Medical Group-Renton Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients
Regents of the University of California CurrentSince Jul 2, 2024 Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

File 57326
Los Angeles, CA 90074

4520 Executive Dr
San Diego, CA 92121
Phone (858) 249-1429

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971

4011 Talbot Rd S
Ste 460
Renton, WA 98055
Phone (425) 251-5110

Interoperability endpoints

  • Direct secure messaging: mjohn105996@direct.valleymed.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1490400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1013448588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 57326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900747326",
            "telephone_number": "800-926-8273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 CAMPUS POINT DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371300",
            "telephone_number": "800-926-8273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 E 102nd St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100295204",
            "country_code": "US",
            "telephone_number": "212-659-8551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100166402",
            "country_code": "US",
            "telephone_number": "212-263-7300",
            "fax_number": "212-263-6022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1959 NE Pacific Street",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "98195",
            "country_code": "US",
            "telephone_number": "206-616-8378",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4011 Talbot Rd S Ste 460",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980555791",
            "country_code": "US",
            "telephone_number": "425-690-3484",
            "fax_number": "425-690-9084",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 W Arbor Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921039000",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4520 Executive Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921213018",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHN",
        "first_name": "MIRA",
        "middle_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-25",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A196769",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61153632",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WA",
            "license": "MD61153632",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A196769",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "298729",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "A196769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.