Active NPI
Miriam Leah Fishman, PSY.D.
- Clinical Child & Adolescent Psychologist
- Minneapolis, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- PSY28166
- Practice address
- 800 E 28TH St FL 6
Minneapolis, MN 55407-3723 - Phone
- (612) 863-5327
- Fax
- (612) 863-2596
- NPI assigned
- Sep 16, 2010
- Last updated
- Feb 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP6490 | MN | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY28166 | CA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSB 35417 | CA |
Addresses
Primary practice location
800 E 28TH St FL 6
Minneapolis, MN 55407-3723
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Other practice location 1
3434 W Shaw Ave
Fresno, CA 93711-3216
Phone (559) 271-1186 ext. 126
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000
800 E 28TH St
Minneapolis, MN 55407-3723
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.6 of 100
- Quality
- 72.5
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 77.07
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSB 35417 | CA | MD | Clinical Child & Adolescent Psychologist |
| PSY28166 | CA | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients |
Locations
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
800 E 28th St
Fl 6
Minneapolis, MN 55407
Phone (612) 863-5327
Interoperability endpoints
- mfishman459873@excellian.direct.allina.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Allina Health Buffalo Specialty Clinic
- Obstetrics & Gynecology Physician
- Buffalo, MN
- NPI 1295272342
-
dba Minnesota Perinatal Physicians - Mercy
- Maternal & Fetal Medicine Physician
- Coon Rapids, MN
- NPI 1447527767
-
dba Allina Health TeleRheumatology
- Rheumatology Physician
- Coon Rapids, MN
- NPI 1952146516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580947200000",
"number": "1306154968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E 28TH ST FL 6",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073723",
"telephone_number": "612-863-5327",
"fax_number": "612-863-2596"
}
],
"practiceLocations": [
{
"address_1": "3434 W Shaw Ave",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937113216",
"country_code": "US",
"telephone_number": "559-271-1186 x126",
"fax_number": "559-271-8041",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FISHMAN",
"first_name": "MIRIAM",
"middle_name": "LEAH",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-16",
"last_updated": "2020-02-06",
"certification_date": "2020-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP6490",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSY28166",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "CA",
"license": "PSB 35417",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; 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.