Mashhud M Mirza, M.D.

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

E1005 Issued in AR

Practice address

1120 State Highway 77
Ste 1
Marion, AR 72364-9027

Phone

(870) 733-1177

Fax

(870) 702-6128

NPI assigned

Jun 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN, AR2 enrollments

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 2

Specialty

Internal MedicineAlso: Nephrology

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mid-South Renal Clinic, PLCGroup PAC ID 2062303795, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DaVita Renal Care Marion at Home Dialysis facility, Marion, AR, CCN 042573
• DaVita Osceola Dialysis Dialysis facility, Osceola, AR, CCN 042534
• DaVita Whitehaven Renal Center Dialysis facility, Memphis, TN, CCN 442655

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmirza30670@mlh.direct-ci.com
• Direct secure messaging: mashhud.mirza@direct.davitaphysiciansolutions.com

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.

• Mid-South Renal Clinic, PLC

  • Specialist
  • Marion, AR
  • NPI 1093724346

  TN

  Medicare reassignment Care Compare group NPD Authorized official
• Mid-South Nephrology Consultants PLLC

  • Nephrology Physician
  • Memphis, TN
  • NPI 1346219342
  NPD (past)

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

• Isd Renal Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Marion, AR
  • NPI 1003861642

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267488000000",
    "number": "1528003050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55",
            "city": "MARION",
            "state": "AR",
            "postal_code": "723640055",
            "telephone_number": "870-733-1177",
            "fax_number": "870-702-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 STATE HIGHWAY 77",
            "address_2": "STE 1",
            "city": "MARION",
            "state": "AR",
            "postal_code": "723649027",
            "telephone_number": "870-733-1177",
            "fax_number": "870-702-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "MASHHUD",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2010-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "AR",
            "license": "E1005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3154566",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5K483",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136518001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110217316",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Michael
• Mid- South Rheumatology & Internal Medicine
• Mid-South Personal Care Agency, LLC
• Mid-South Renal Clinic, PLC
• Jessica Miller, LPEI
• Mitchell Family Medicine, LLC
• Aarin Austin Mitchell, LPC
• Aaron Jay Mitchell, M.D.
• MK Therapy Co
• Elizabeth Moise, RN

• Nephrology Physician in Marion, AR
• Providers in Marion, AR by specialty
• Nephrology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2010; 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.