NPIMap

Organization Active NPI

M a Mirza, LLC

Doing business as White Oak Psychiatric Services

  • Prescribing (Medical) Psychologist
  • Lee's Summit, MO
National Provider Identifier
1376757617
Registry record updated Mar 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
License
RICIO Issued in MO
Legal business name
M A MIRZA, LLC
Doing business as
White Oak Psychiatric Services
Practice address
4045 NE Lakewood Way
Suite 130
Lees Summit, MO 64064-1799
Phone
(816) 886-2184
Fax
(816) 886-2397
NPI assigned
May 9, 2007
Reactivated
May 14, 2013
Last updated
Mar 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2014

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

Authorized official

Name
Dr. Mohammed Azher Mirza, M.D.NPI 1710067822
Title
Owner
Phone
(816) 228-5335

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
Prescribing (Medical) Psychologist 103TP0016X RICIO MO Primary

Addresses

Primary practice location

4045 NE Lakewood Way
Suite 130
Lees Summit, MO 64064-1799

Mailing address

4045 NE Lakewood Way
Suite 130
Lees Summit, MO 64064-1799
Phone (816) 886-2184

Other names 1

  • WHITE OAK PSYCHIATRIC SERVICES Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140319001260 MO Part B Supplier - Clinic/Group Practice 4284865056 Receives reassigned benefits from 14 practitioners
Practice locations: Columbia, MO; Kansas City, MO; Lees Summit, MO

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1010 Carondelet Dr
Ste 407
Kansas City, MO 64114
Phone (816) 886-2184

4045 NE Lakewood Way
Ste ST130
Lees Summit, MO 64064

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1376757617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 NE LAKEWOOD WAY",
            "address_2": "SUITE 130",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641799",
            "telephone_number": "816-886-2184",
            "fax_number": "816-886-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 NE LAKEWOOD WAY",
            "address_2": "SUITE 130",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641799",
            "telephone_number": "816-886-2184",
            "fax_number": "816-886-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A MIRZA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2014-03-21",
        "deactivation_date": "2008-08-14",
        "reactivation_date": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "MIRZA",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "AZHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-228-5335",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "MO",
            "license": "RICIO",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WHITE OAK PSYCHIATRIC SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lee's Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; 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.