Active NPI
Mira Medical Associates, PLLC
- Clinical Neuropsychologist
- Tinley Park, IL
National Provider Identifier
1588370464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- Legal business name
- MIRA MEDICAL ASSOCIATES, PLLC
- Practice address
- 6775 Prosperi Dr
Tinley Park, IL 60477-4789 - Phone
- (708) 726-6472
- Fax
- (708) 671-8446
- NPI assigned
- Jan 25, 2023
- Last updated
- Jan 25, 2023
- Organization subpart
- Yes
- Parent organization
- MIRA NEURO BEHAVORIAL HEALTH CARE, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Christopher Higgins
- Title
- President
- Phone
- (708) 726-6472
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | NU | ||
| Clinical Neuropsychologist | 103G00000X | NU | Primary | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | NU | ||
| Nutritionist | 133N00000X | NU | ||
| Pediatric Adolescent Medicine Physician | 2080A0000X | NU |
Addresses
Primary practice location
6775 Prosperi Dr
Tinley Park, IL 60477-4789
Mailing address
6775 Prosperi Dr
Tinley Park, IL 60477-4789
Phone (708) 726-6472
National Provider Directory
National Provider Directory- Part of
- Mira Neuro Behavioral Health Care LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674604800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1674604800000",
"number": "1588370464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6775 PROSPERI DR",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604774789",
"telephone_number": "708-726-6472",
"fax_number": "708-671-8446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6775 PROSPERI DR",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604774789",
"telephone_number": "708-726-6472",
"fax_number": "708-671-8446"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MIRA MEDICAL ASSOCIATES, PLLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MIRA NEURO BEHAVORIAL HEALTH CARE, LLC",
"enumeration_date": "2023-01-25",
"last_updated": "2023-01-25",
"certification_date": "2023-01-25",
"status": "A",
"authorized_official_last_name": "HIGGINS",
"authorized_official_first_name": "CHRISTOPHER",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "708-726-6472"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tinley Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.