Miranda Kalish, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-799 Issued in AR

Practice address

4600 Memorial Dr
Belleville, IL 62226-5368

Phone

(618) 235-8720

NPI assigned

Feb 19, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miranda Boeckman Former name

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Ies Arkansas PLLC

  • Emergency Medicine Physician
  • Dallas, TX
  • NPI 1598488090

  AR

  Medicare reassignment
• South Arkansas Emergency Physicians LLP

  • Emergency Medicine Physician
  • El Dorado, AR
  • NPI 1942435458
  Medicare reassignment
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  AR

  Medicare reassignment
• Springdale- Bentonville HBP Services, LLC

  • Neonatal-Perinatal Medicine Physician
  • Bentonville, AR
  • NPI 1811762701
  Medicare reassignment
• South Arkansas Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Siloam Springs, AR
  • NPI 1225452055

  Physician Assistant

  NPD
• Granite City Clinic Corp

  • Certified Registered Nurse Anesthetist
  • Granite City, IL
  • NPI 1003892464
  NPD (past)

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

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1588056147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265368",
            "telephone_number": "618-235-8720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265368",
            "telephone_number": "618-235-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALISH",
        "first_name": "MIRANDA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-19",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085005407",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "BOECKMAN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kendra P Kaesbereg, D.C.
• Kaesberg Chiropractic Clinic PC
• Karsyn Brin Kaiser
• Emily Ruth Kalaman
• Kaleidoscope Heart Counseling, LLC
• Prasad V Kandula, M.D.
• Sarah R Karban, PT
• Rachel Katka
• Pankaj K Kaul, M.D.
• Kayla L Anderson LLC

• Physician Assistant in Belleville, IL
• Providers in Belleville, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.