NPIMap

Organization Active NPI

Mariam Amiri

  • Podiatrist
  • Apple Valley, CA
National Provider Identifier
1235140336
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E4049 Issued in CA
Legal business name
MARIAM AMIRI
Practice address
18225 Outer Highway 18
Apple Valley, CA 92307
Phone
(760) 242-5096
Fax
(909) 242-3814
NPI assigned
Aug 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Dr. Mariam S Amiri, DPMNPI 1093826539
Title
Owner
Phone
(909) 796-3707

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X E4049 CA Primary

Addresses

Primary practice location

18225 Outer Highway 18
Apple Valley, CA 92307

Mailing address

PO Box 1069
Loma Linda, CA 92354-1069
Phone (909) 796-3707

Other identifiers 1

IdentifierTypeStateIssuer
GRE001751MedicaidCA

Other names 1

  • Loma Linda Foot and Ankle Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031222000596 CA Part B Supplier - Clinic/Group Practice 0446158968 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
Practice locations: Loma Linda, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

16017 Tuscola Rd
Ste D
Apple Valley, CA 92307
Phone (760) 243-4327

11332 Mountain View Ave
Loma Linda, CA 92354

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1235140336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1069",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923541069",
            "telephone_number": "909-796-3707",
            "fax_number": "909-796-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18225 OUTER HIGHWAY 18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "92307",
            "telephone_number": "760-242-5096",
            "fax_number": "909-242-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIAM AMIRI",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "AMIRI",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-796-3707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRE001751",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loma Linda Foot and Ankle Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.