Poonam Mishra, D.O.

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

593360315 Issued in FL

Practice address

401 N Wickham Rd
Suite H
Melbourne, FL 32935-8659

Phone

(321) 757-5105

Fax

(321) 757-5104

NPI assigned

Oct 25, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

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.

• Osler Medical Inc

  • Multi-Specialty Clinic/Center
  • Melbourne, FL
  • NPI 1356308670
  NPD (past)

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423180800000",
    "number": "1306836952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N WICKHAM RD",
            "address_2": "SUITE H",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358659",
            "telephone_number": "321-757-5105",
            "fax_number": "321-757-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N WICKHAM RD",
            "address_2": "SUITE H",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329358659",
            "telephone_number": "321-757-5105",
            "fax_number": "321-757-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHRA",
        "first_name": "POONAM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-25",
        "last_updated": "2015-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "FL",
            "license": "593360315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MAB GROUP",
            "identifier": "40462",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "57174",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Paul Minuski Jr., D.C., APRN, AGNP-C
• Eliett Mary Miranda
• Jason Miranda, CRNA
• Whitney Miranda, CNM
• Kristin Cavanah Mirda, D.M.D.
• Brittany Devine Misrahi, M.S.
• Cadence Marie Mister
• Mitchell Kaplan DC PA
• Mitchell R Greenberg, DC, Inc
• Chakiah Tucker Mitchell

• Adult Medicine Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Adult Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.