Active NPI
Jeffrey Charles Mirsky, M.D.
- Psychiatry Physician
- Chicago, IL
National Provider Identifier
1376899005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 125060890
- Practice address
- 1653 W Congress Pkwy
Chicago, IL 60612-3833 - Phone
- (312) 947-2336
- NPI assigned
- Jul 31, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 125060890 | IL | Primary |
Addresses
Primary practice location
1653 W Congress Pkwy
Chicago, IL 60612-3833
Mailing address
1653 W Congress Pkwy
Chicago, IL 60612-3833
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 18, 2016 through Jul 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125060890 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343692800000",
"number": "1376899005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1653 W CONGRESS PKWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1653 W CONGRESS PKWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123833",
"telephone_number": "312-947-2336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRSKY",
"first_name": "JEFFREY",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-31",
"last_updated": "2012-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "125060890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.