Mirage Medical Group

Primary specialty

SpecialistTaxonomy code 174400000X

License

A51307 Issued in CA

Legal business name

MIRAGE MEDICAL GROUP

Practice address

69844 Highway 111 Ste K
One Hawkeye Park
Rancho Mirage, CA 92270-2849

Phone

(760) 770-4166

NPI assigned

Feb 27, 2009

Last updated

Feb 27, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Zoran Rubakovich

Title

Director of Operations

Phone

(760) 346-4003

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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.

• Philip Becker, D.O.

  • General Practice Physician
  • La Quinta, CA
  • NPI 1225057862
  NPD (past)
• Howard Michael Miller, M.D.

  • Dermatology Physician
  • Palm Desert, CA
  • NPI 1992773477

  Specialist

  NPD (past)

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235692800000",
    "number": "1528208758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44650 VILLAGE CT STE 100",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922603812",
            "telephone_number": "760-346-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69844 HIGHWAY 111 STE K",
            "address_2": "ONE HAWKEYE PARK",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922702849",
            "telephone_number": "760-770-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRAGE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-27",
        "last_updated": "2009-02-27",
        "status": "A",
        "authorized_official_last_name": "RUBAKOVICH",
        "authorized_official_first_name": "ZORAN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "760-346-4003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A51307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A51307",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mirage Aesthetic Concepts Surgical Center
• Mirage Ambulatory Surgery Center, Inc
• Mirage Care LLC
• Mirage Center Outpatient Surgery
• Mirage Endoscopy Center, L.P.
• Mirage on Call Medical Group Inc
• Mirage Pain and Rehabilitation Associates a Medical Group Inc (Desert Pain & Rehabilitation Associates)
• Mirage Pain and Rehabilitation Associates a Medical Group, Inc. (Desert Pain & Rehabilitation Associates)
• Mirage Physical Therapy, Inc
• Mirage Surgery Center

• Specialist in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2009; 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.