NPIMap

Organization Active NPI

Mira Women's Health and Midwifery

  • Gynecology Physician
  • Boca Raton, FL
National Provider Identifier
1427894880
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
MIRA WOMEN'S HEALTH AND MIDWIFERY
Practice address
1601 Clint Moore Rd Ste 210
Boca Raton, FL 33487-5716
Phone
(561) 488-1801
Fax
(561) 451-1480
NPI assigned
Jul 5, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Authorized official

Name
Kenneth A Konsker, MDNPI 1154309771
Title
Ceo and Physician
Phone
(561) 789-0559

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
MidwifeGroup: 193200000X MULTI-SPECIALTY GROUP 176B00000X
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X Primary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X

Addresses

Primary practice location

1601 Clint Moore Rd Ste 210
Boca Raton, FL 33487-5716

Mailing address

1601 Clint Moore Rd Ste 210
Boca Raton, FL 33487-5716
Phone (561) 488-1801

Other practice location 1

660 Glades Rd Ste 340
Boca Raton, FL 33431-6468
Phone (561) 488-1801

Other identifiers 1

IdentifierTypeStateIssuer
14278954880MedicaidFL

Other names 1

  • Mira Women's Health and Midwifery Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240909004487 FL Part B Supplier - Clinic/Group Practice 5890235519 Receives reassigned benefits from 13 practitioners
Practice locations: Boca Raton, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0895352Mira Women's Health and Midwifery660 Glades Road Suite 240, Boca Raton, FL 33431Certificate of waiverJul 15, 2027

National Provider Directory

National Provider Directory

Locations

1150 N 35th Ave
Ste 405
Hollywood, FL 33021
Phone (954) 961-0253

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1720137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1427894880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CLINT MOORE RD STE 210",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334875716",
            "telephone_number": "561-488-1801",
            "fax_number": "561-451-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 CLINT MOORE RD STE 210",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334875716",
            "telephone_number": "561-488-1801",
            "fax_number": "561-451-1480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "660 Glades Rd Ste 340",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334316468",
            "country_code": "US",
            "telephone_number": "561-488-1801",
            "fax_number": "561-451-1480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIRA WOMEN'S HEALTH AND MIDWIFERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-05",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "KONSKER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO AND PHYSICIAN",
        "authorized_official_telephone_number": "561-789-0559",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14278954880",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mira Women's Health and Midwifery",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Mira Women's Health and Midwifery",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.