NPIMap

Individual provider Active NPI

Harvey Lee Mirly, M.D.

  • Orthopaedic Hand Surgery Physician
  • Belleville, IL
National Provider Identifier
1447203971
Registry record updated Feb 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
036085921 Issued in IL
Practice address
4700 Memorial Dr
Ste. 340
Belleville, IL 62226-5373
Phone
(618) 235-7065
Fax
(618) 235-9020
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Hand Surgery Physician 207XS0106X 036085921 IL Primary

Addresses

Primary practice location

4700 Memorial Dr
Ste. 340
Belleville, IL 62226-5373

Mailing address

4700 Memorial Dr
Ste. 340
Belleville, IL 62226-5373
Phone (618) 234-9884

Other identifiers 2

IdentifierTypeStateIssuer
1447203971MedicaidIL
6394100002OtherILMEDICARE DME

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036085921ILMDOrthopaedic Hand Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Belleville Orthopedic Surgeons LTD PastSince Jul 1, 2010 Accepting new patients
Fairview Heights Medical Group SC Past Accepting new patients
Belleville Orthopedics, P.C. PastSince Jan 3, 2005 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: hmirly161643@direct.carenet.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1447203971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 MEMORIAL DR",
            "address_2": "STE. 340",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265373",
            "telephone_number": "618-234-9884",
            "fax_number": "618-235-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 MEMORIAL DR",
            "address_2": "STE. 340",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265373",
            "telephone_number": "618-235-7065",
            "fax_number": "618-235-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRLY",
        "first_name": "HARVEY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "IL",
            "license": "036085921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447203971",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "6394100002",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4700 Memorial Dr",
            "address_2": "Ste. 340",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.