Active NPI
Sahaam Mirza
- Surgery Physician
- Kansas City, KS
National Provider Identifier
1417709619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 9411970
- Practice address
- 3901 Rainbow Blvd
Kansas City, KS 66160-8500 - Phone
- (913) 588-6124
- NPI assigned
- Apr 2, 2024
- Last updated
- Jun 12, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Surgery Physician | 208600000X | 9411970 | KS | Primary |
Addresses
Primary practice location
3901 Rainbow Blvd
Kansas City, KS 66160-8500
Mailing address
3901 Rainbow Blvd
Kansas City, KS 66160-8500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240619000317 | KS | Order and Referring Only - General Surgery | 5092258004 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9411970 | KS | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718150400000",
"number": "1417709619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3901 RAINBOW BLVD",
"city": "KANSAS CITY",
"state": "KS",
"postal_code": "661608500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 RAINBOW BLVD",
"city": "KANSAS CITY",
"state": "KS",
"postal_code": "661608500",
"telephone_number": "913-588-6124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRZA",
"first_name": "SAHAAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-02",
"last_updated": "2024-06-12",
"certification_date": "2024-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "KS",
"license": "9411970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.