Individual provider Active NPI

Miriam Leah Fishman, PSY.D.

  • Clinical Child & Adolescent Psychologist
  • Minneapolis, MN
National Provider Identifier
1306154968
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PSY28166 Issued in CA
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, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200214001398 MN Practitioner - Clinical Psychologist 5991131757 Reassigns benefits to 1 organization

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
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

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 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSB 35417CAMDClinical Child & Adolescent Psychologist
PSY28166CAMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Mar 30, 2020 Accepting new patients
Allina Health System CurrentSince Mar 30, 2020 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.