NPIMap

Organization Active NPI

Mariam Amiri

  • Podiatrist
  • Loma Linda, CA
National Provider Identifier
1497769731
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E4049 Issued in CA
Legal business name
MARIAM AMIRI
Practice address
11332 Mountain View Ave
Suite a
Loma Linda, CA 92354-3854
Phone
(909) 796-3707
Fax
(909) 796-3709
NPI assigned
Jul 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Authorized official

Name
Dr. Mariam Shanaz Amiri, MD
Title
Owner
Phone
(909) 796-3707

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X E4049 CA Primary

Addresses

Primary practice location

11332 Mountain View Ave
Suite a
Loma Linda, CA 92354-3854

Mailing address

PO Box 1059
Loma Linda, CA 92354-1059
Phone (909) 796-3707

Other identifiers 1

IdentifierTypeStateIssuer
GRE001750MedicaidCA

Other names 1

  • Loma Linda Foot and Ankle Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031222000596 CA Part B Supplier - Clinic/Group Practice 0446158968 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Loma Linda, CA
O20100930030666 CA DME Supplier - Physician - Podiatry 0446158968 Practice locations: Loma Linda, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1497769731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1059",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923541059",
            "telephone_number": "909-796-3707",
            "fax_number": "909-796-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11332 MOUNTAIN VIEW AVE",
            "address_2": "SUITE A",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543854",
            "telephone_number": "909-796-3707",
            "fax_number": "909-796-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIAM AMIRI",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A",
        "authorized_official_last_name": "AMIRI",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_middle_name": "SHANAZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-796-3707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E4049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRE001750",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loma Linda Foot and Ankle Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Loma Linda Foot and Ankle Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; 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.