Mirshed Medical Center S C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036-091913 Issued in IL

Legal business name

MIRSHED MEDICAL CENTER S C

Practice address

4255 W 63Rd St
Chicago, IL 60629-5041

Phone

(773) 424-4048

Fax

(773) 424-6463

NPI assigned

May 5, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Nayeh Edwin Mirshed, M.D.NPI 1689662892

Title

Executive Director

Phone

(773) 424-4048

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nayeh E Mirshed, M.D.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1689662892
  Medicare reassignment Care Compare group NPD Authorized official
• Luvianca J. Fonseca, M.D.

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1205824406
  Medicare reassignment Care Compare group NPD
• Lizandra Anzo, PA

  • Physician Assistant
  • Chicago, IL
  • NPI 1376099879
  Medicare reassignment

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1083880637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606295041",
            "telephone_number": "773-424-4048",
            "fax_number": "773-424-6463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606295041",
            "telephone_number": "773-424-4048",
            "fax_number": "773-424-6463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRSHED MEDICAL CENTER S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "MIRSHED",
        "authorized_official_first_name": "NAYEH",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-424-4048",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-091913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lavisha Prakash Mirpuri, M.D
• Pranav Mirpuri
• Mirrored You Counseling Services, PLLC
• Mirroring Wellness LLC
• Megan Kathleen Mirsberger
• Nayeh E Mirshed, M.D.
• Jeffrey Charles Mirsky, M.D.
• Kidus Miruts, MD
• Basil Francis Mirza
• Faraz Ali Mirza, MS, OTR/L

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.