NPIMap

Individual provider Active NPI

Miriam Ida Harris, M.D.

  • Family Medicine Physician
  • Willits, CA
National Provider Identifier
1033476452
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A129594 Issued in CA
Practice address
1245 S Main St
Willits, CA 95490
Phone
(707) 459-6861
Fax
(707) 459-3057
NPI assigned
Apr 23, 2012
Last updated
Nov 29, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X A129594 CA Primary

Addresses

Primary practice location

1245 S Main St
Willits, CA 95490

Mailing address

1245 S Main St
Willits, CA 95490-4305
Phone (707) 459-6861

Other practice location 1

155 N Fresno St
Fresno, CA 93701-2302
Phone (559) 499-6520

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151103000717 CA Practitioner - Family Practice 8729398896 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arizona College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1245 S Main St
Willits, CA 95490-4305
Phone (707) 459-6861

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.41 of 100Reported as group
Quality
86.32
Promoting interoperability
95
Improvement activities
40
Cost
66.55

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A129594CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John R Glyer D Mills Matheson & Margaret Arner MDS PTR CurrentSince Nov 6, 2018 Accepting new patients

Locations

1245 S Main St
Willits, CA 95490
Phone (707) 459-6861

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Baechtel Creek Medical ClinicWillits, CA, CCN 053968 Rural health clinic 5% Or Greater Direct Ownership Interest (25%)
General Partnership Interest (25%)		 Jan 1, 2020
Jan 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543449600000",
    "number": "1033476452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 S MAIN ST",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "954904305",
            "telephone_number": "707-459-6861",
            "fax_number": "707-459-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 S MAIN ST",
            "city": "WILLITS",
            "state": "CA",
            "postal_code": "95490",
            "telephone_number": "707-459-6861",
            "fax_number": "707-459-3057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 N Fresno St",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937012302",
            "country_code": "US",
            "telephone_number": "559-499-6520",
            "fax_number": "559-499-6521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "MIRIAM",
        "middle_name": "IDA",
        "name_prefix": "Miss",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-23",
        "last_updated": "2018-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A129594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willits, CA

Sources for this page

Verify at the official NPI Registry.