Gennady G Miroshnichenko, MD

Primary specialty

Gynecologic Oncology PhysicianTaxonomy code 207VX0201X

License

P4595 Issued in TX

Practice address

1201 S Main St
Fort Worth, TX 76104-4804

Phone

(817) 702-6500

Fax

(817) 702-6561

NPI assigned

Jun 12, 2012

Last updated

Feb 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Gynecological OncologyAlso: Obstetrics/Gynecology

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acclaim Physician Group IncGroup PAC ID 4587963582, 520 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• JPS Health Network Hospital, Fort Worth, TX, CCN 450039

Merit-based Incentive Payment System (MIPS)

Final score

96.38 of 100Reported as group

Quality

80.41

Promoting interoperability

100

Improvement activities

40

Cost

78.69

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Acclaim Physician Group, Inc

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1780076562
  Medicare reassignment Care Compare group
• Tarrant County Hospital District

  dba JPS Health Network

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1992753222
  NPD (past)

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

• Tarrant County Hospital District

  dba JPS Health Network

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1992753222
  Care Compare affiliation

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1164784450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 732973",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753732973",
            "telephone_number": "817-702-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S MAIN ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044804",
            "telephone_number": "817-702-6500",
            "fax_number": "817-702-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIROSHNICHENKO",
        "first_name": "GENNADY",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-12",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "P4595",
            "primary": false
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "TX",
            "license": "P4595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307460101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8DM684",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David G Miracle, MA, LPC-ASSOCIATE
• Antonio Miranda, PHD, RD, LD, CDCES
• Erin Miranda, LMSW
• Mario Miranda, DDS
• Regina C Miranda, DDS
• Ambir Rauf Mirza, MD
• Angela Sadat Mirzadeh, DO
• Akberet Girmay Misgna
• Regbe Misgna
• Mission Travis Mercy (Mercy Clinic of Fort Worth)

• Gynecologic Oncology Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Gynecologic Oncology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; 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.