NPIMap

Organization Active NPI

Iqbal M Mirza MD Professional Corporation

  • Anesthesiology Physician
  • Los Gatos, CA
National Provider Identifier
1417222985
Registry record updated Mar 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
IQBAL M MIRZA MD PROFESSIONAL CORPORATION
Practice address
555 Knowles Dr
115
Los Gatos, CA 95032-1549
Phone
(408) 655-2340
Fax
(408) 741-8802
NPI assigned
Mar 17, 2012
Last updated
Mar 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2012

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

Authorized official

Name
Iqbal M Mirza, MDNPI 1043331192
Title
President/Owner
Phone
(408) 655-2340

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
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

555 Knowles Dr
115
Los Gatos, CA 95032-1549

Mailing address

PO Box 3612
Saratoga, CA 95070-1612
Phone (408) 655-2340

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081112000138 CA Part B Supplier - Clinic/Group Practice 2163581752 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
Practice locations: Los Gatos, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1331942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331942400000",
    "number": "1417222985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3612",
            "city": "SARATOGA",
            "state": "CA",
            "postal_code": "950701612",
            "telephone_number": "408-655-2340",
            "fax_number": "408-741-8802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 KNOWLES DR",
            "address_2": "115",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321549",
            "telephone_number": "408-655-2340",
            "fax_number": "408-741-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IQBAL M MIRZA MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-17",
        "last_updated": "2012-03-17",
        "status": "A",
        "authorized_official_last_name": "MIRZA",
        "authorized_official_first_name": "IQBAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "408-655-2340",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2012; 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.