Individual provider Active NPI

Jawairia Sahar K Mirza, MD

  • Hospitalist Physician
  • West Bend, WI
National Provider Identifier
1619557170
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
84200 Issued in WI
Practice address
3200 Pleasant Valley Rd
West Bend, WI 53095-9274
Phone
(262) 334-5553
Fax
(262) 836-7301
NPI assigned
Apr 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 84200 WI
Hospitalist Physician 208M00000X 84200 WI Primary

Addresses

Primary practice location

3200 Pleasant Valley Rd
West Bend, WI 53095-9274

Mailing address

3200 Pleasant Valley Rd
West Bend, WI 53095-9274
Phone (262) 334-5553

Other practice location 1

4001 N 3rd St Ste 290
Phoenix, AZ 85012-2071
Phone (602) 812-3132

Other practice location 2

350 W Thomas Rd
Phoenix, AZ 85013-4496
Phone (602) 406-2175

Other identifiers 1

IdentifierTypeStateIssuer
1619557170MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20241014001242 WI Practitioner - HospitalistPractitioner - Internal Medicine 6406388628 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

8701 W Watertown Plank
Milwaukee, WI 53226-3548
Phone (414) 805-3666

8701 Watertown Plank Rd
Room 4041 MFRC
Milwaukee, WI 53226-3548
Phone (414) 805-3666

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
84200WIMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients

Locations

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

10000 W Innovation Dr
Ste 300
Wauwatosa, WI 53226

3200 Pleasant Valley Rd
West Bend, WI 53095
Phone (262) 334-5533

Interoperability endpoints

  • Direct secure messaging: jmirza838243@direct.froedtert.com

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1619557170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 PLEASANT VALLEY RD",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959274",
            "telephone_number": "262-334-5553",
            "fax_number": "262-836-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 PLEASANT VALLEY RD",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959274",
            "telephone_number": "262-334-5553",
            "fax_number": "262-836-7301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4001 N 3rd St Ste 290",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850122071",
            "country_code": "US",
            "telephone_number": "602-812-3132",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 W Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134496",
            "country_code": "US",
            "telephone_number": "602-406-2175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "JAWAIRIA SAHAR",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-09",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "84200",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WI",
            "license": "84200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619557170",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.