Jacob Isaac Mirman, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

33594 Issued in MN

Practice address

4201 Excelsior Blvd
Saint Louis Park, MN 55416-4728

Phone

(952) 933-8900

Fax

(952) 945-9536

NPI assigned

Jun 12, 2006

Last updated

Sep 18, 2025By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in MN

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

Internal Medicine

Education

University of Minnesota Medical School, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Life Medical PAGroup PAC ID 6204938350, 8 clinicians

Minnesota Medical and Rehabilitative Services LLCGroup PAC ID 6406764703, 8 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Minnesota Medical and Rehabilitative Services, LLC

  dba Minnesota Medical and Rehabilitation

  • Physical Therapist
  • St Louis Park, MN
  • NPI 1154302545
  Medicare reassignment Care Compare group NPD Authorized official
• Life Medical, P.a.

  dba Life Medical

  • Multi-Specialty Clinic/Center
  • St Louis Park, MN
  • NPI 1740222496
  Medicare reassignment Care Compare group Authorized official
• Homeopathic Medical Clinic

  • Health Service Clinic/Center
  • Minneapolis, MN
  • NPI 1235381476
  Authorized official Same address or phone
• Primary Care & Rehabilitation Clinics, Inc.

  • Multi-Specialty Clinic/Center
  • St Louis Park, MN
  • NPI 1306842547
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1568404440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-8900",
            "fax_number": "952-945-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-8900",
            "fax_number": "952-945-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRMAN",
        "first_name": "JACOB",
        "middle_name": "ISAAC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "33594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "959862600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Minor Medical Squad PLLC
• Nicholas Alexander Minotte
• Deborah Hametz Mintz, OT
• Minute Health LLC
• Miracle Mile Dentistry PA (36th Street Dental)
• Megan A. Misgen, CNP
• Shardendu Mishra, MBBS
• Agne Miskinis
• Andrew James Misselt, MD
• Paige N Misselt, MD

• Internal Medicine Physician in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; 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.