Michael Av Mirzai, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

12502 Issued in ND

Practice address

1800 E Interstate Ave Ste B
Bismarck, ND 58503-1566

Phone

(701) 323-6543

Fax

(701) 323-5492

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Meharry Medical College School of Medicine, 1996

Medicare assignment

May accept Medicare assignment

Group practices

Maui Health System a Kaiser Foundation Hospitals LLCGroup PAC ID 9830476159, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Maui Memorial Medical Center Hospital, Wailuku, HI, CCN 120002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Maui Health System a Kaiser Foundation Hospitals LLC

  • General Acute Care Hospital
  • Wailuku, HI
  • NPI 1013379460
  Medicare reassignment Care Compare group NPD
• Maui Health System a Kaiser Foundation Hospitals LLC

  • Specialist
  • Wailuku, HI
  • NPI 1669834016
  NPD
• Maui Health System a Kaiser Foundation Hospitals LLC

  • Critical Access Hospital
  • Kula, HI
  • NPI 1861854226
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Maui Health System a Kaiser Foundation Hospitals LLC

  • General Acute Care Hospital
  • Wailuku, HI
  • NPI 1013379460
  Care Compare affiliation

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1508909540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E INTERSTATE AVE STE B",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031566",
            "telephone_number": "701-323-6543",
            "fax_number": "701-323-5492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 E Broadway Ave",
            "address_2": "CHI/St. Alexius Medical Center",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585014520",
            "country_code": "US",
            "telephone_number": "701-530-7353",
            "fax_number": "701-530-7319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRZAI",
        "first_name": "MICHAEL",
        "middle_name": "AV",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "12502",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "K-6777",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "HI",
            "license": "12616",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "HI",
            "license": "12616",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "K-6777",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "ND",
            "license": "12502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452924",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Henry Mindt IV
• Linaya Ming, MS, CCC-SLP
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• Heidy Miranda, LMSW
• Calsey Mischel, M.D.
• Kelsey Mischel, DPT
• Amy Mischke
• Missouri Basin Anesthesia, PLLC
• Missouri River Dental, PC

• Child & Adolescent Psychiatry Physician in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Child & Adolescent Psychiatry Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; 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.
• 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.