Individual provider Active NPI

Mirjana Dimovska

  • Emergency Medicine Physician
  • Detroit, MI
National Provider Identifier
1114345782
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4301105371 Issued in MI
Practice address
4201 Saint Antoine St
6G Uhc
Detroit, MI 48201-2153
Phone
(313) 993-2529
NPI assigned
Apr 1, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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
Emergency Medicine Physician 207P00000X 4301105371 MI Primary

Addresses

Primary practice location

4201 Saint Antoine St
6G Uhc
Detroit, MI 48201-2153

Mailing address

4201 Saint Antoine St
6G Uhc
Detroit, MI 48201-2153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170920001006 MI Practitioner - Emergency Medicine 8921300195 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301105371MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Emergency Services CurrentSince Aug 23, 2020 Accepting new patients
Medical Center Emergency Services CurrentSince Aug 14, 2017 Accepting new patients

Locations

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

4201 Saint Antoine St
Ste 3R
Detroit, MI 48201
Phone (313) 745-3330

4201 Saint Antoine St
#6G
Detroit, MI 48201
Phone (313) 993-2529

Interoperability endpoints

  • Direct secure messaging: mdimovsk@direct.dmc.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1114345782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST",
            "address_2": "6G UHC",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST",
            "address_2": "6G UHC",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-993-2529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMOVSKA",
        "first_name": "MIRJANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-01",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301105371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.