NPIMap

Individual provider Active NPI

Marshal J. Mirviss, M.D.

  • Internal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1205820958
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20062 Issued in WI
Practice address
2025 W Oklahoma Ave
Milwaukee, WI 53215-4455
Phone
(414) 389-2790
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20062 WI Primary

Addresses

Primary practice location

2025 W Oklahoma Ave
Milwaukee, WI 53215-4455

Mailing address

PO Box 689711
Milwaukee, WI 53268-9711
Phone (414) 456-3100

Other identifiers 1

IdentifierTypeStateIssuer
30178100MedicaidWI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address marshal.mirviss@ascension.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20080820000488 WI Practitioner - Internal Medicine 0648182303 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Wisconsin, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400

201 N Mayfair Rd
Wauwatosa, WI 53226-4216

4935 S 76TH St
Suite 101
Greenfield, WI 53220-4305
Phone (414) 777-3100

9969 S 27TH St
Franklin, WI 53132-9533
Phone (414) 325-4940

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as apm

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20062WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Internal Medicine CurrentSince Sep 1, 2008 Accepting new patients
Commonwealth Medical Group, LLC Internal Medicine Past Accepting new patients
Ascension All Saints Hospital, Inc Past Accepting new patients

Locations

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

2500 W Layton Ave
Ste 10
Milwaukee, WI 53221
Phone (414) 281-9665

2745 W Layton Ave
Ste 206
Milwaukee, WI 53221
Phone (414) 281-9665

3821 Spring St
Mount Pleasant, WI 53405
Phone (262) 687-8460

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 3

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 7

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1205820958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689711",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532689711",
            "telephone_number": "414-456-3100",
            "fax_number": "414-456-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 W OKLAHOMA AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154455",
            "telephone_number": "414-389-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRVISS",
        "first_name": "MARSHAL",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "20062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30178100",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marshal.mirviss@ascension.org",
            "affiliation": "N",
            "address_1": "2025 W Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532154455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.