Jacquelyn Faith Mirr, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

74576 Issued in MN

Practice address

1687 Woodlane Dr Ste And102
Woodbury, MN 55125-3045

Phone

(651) 600-3035

NPI assigned

Jun 10, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jacquelyn Faith Porter Former name

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

Obstetrics/Gynecology

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minnesota Womens Care PAGroup PAC ID 9638329394, 44 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FAHCDA
• Direct secure messaging: jacquelyn.mirr@mwc.eclinicaldirectplus.com

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.

• Minnesota Women's Care, P.a.

  • Obstetrics & Gynecology Physician
  • Maplwood, MN
  • NPI 1518221779
  Medicare reassignment Care Compare group NPD
• Comprehensive Healthcare for Women, PA

  • Obstetrics & Gynecology Physician
  • Woodbury, MN
  • NPI 1841235595
  NPD
• Healtheast St. John's Hospital

  dba Fairview St John's Hospital

  • General Acute Care Hospital
  • Maplewood, MN
  • NPI 1447218482
  NPD (past)
• Healtheast Woodwinds Hospital

  dba Fairview Woodwinds Hospital

  • General Acute Care Hospital
  • Woodbury, MN
  • NPI 1356309322
  NPD (past)

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1679132989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1687 WOODLANE DR STE 101&102",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253045",
            "telephone_number": "651-600-3035",
            "fax_number": "651-348-8783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1687 WOODLANE DR STE AND102",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253045",
            "telephone_number": "651-600-3035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2603 White Bear Ave N",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551095110",
            "country_code": "US",
            "telephone_number": "651-348-8783",
            "fax_number": "651-528-6149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRR",
        "first_name": "JACQUELYN",
        "middle_name": "FAITH",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-10",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "74576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "PORTER",
            "middle_name": "FAITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Minnesota Speech Specialists, LLC
• Minnesota Urology, PA (Metro Urology)
• Minnetonka Imaging MRI, Inc.
• Minnhealth Family Physicians, P.a. (MinnHealth - Woodbury)
• Shahla Mirbaghri
• Mackenzie Ann Mirsch
• Kenneth Allen Mitchell, PA-C
• Lara Elisabeth Mitchell
• Hafsa Nur Moalin
• Fadiila Mohamed

• Obstetrics & Gynecology Physician in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Obstetrics & Gynecology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.