NPIMap

Individual provider Active NPI

Shahin Michael Mirmanesh, M.D.

  • Specialist
  • Marlton, NJ
National Provider Identifier
1679505325
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MA06992000 Issued in NJ
Practice address
12000 Lincoln Dr W
Suite 405
Marlton, NJ 08053-3402
Phone
(856) 985-0203
Fax
(856) 985-0010
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 25MA06992000 NJ Primary

Addresses

Primary practice location

12000 Lincoln Dr W
Suite 405
Marlton, NJ 08053-3402

Mailing address

1 Star Splitter CT
Voorhees, NJ 08043-9517
Phone (856) 985-0203

Other identifiers 1

IdentifierTypeStateIssuer
8584800MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040325000775 NJ Practitioner - Internal Medicine 1052203106 Practice locations: Marlton, NJ

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

651 Route 73 N
Suite 405
Marlton, NJ 08053-3452
Phone (856) 985-0203

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.55 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
75.16

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Adult Medicine of SNJ PA Specialist CurrentSince Jan 1, 1990 Accepting new patients

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

Hospital & facility affiliations 10

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285200000000",
    "number": "1679505325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 STAR SPLITTER CT",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080439517",
            "telephone_number": "856-985-0203",
            "fax_number": "856-985-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 LINCOLN DR W",
            "address_2": "SUITE 405",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533402",
            "telephone_number": "856-985-0203",
            "fax_number": "856-985-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRMANESH",
        "first_name": "SHAHIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2010-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA06992000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8584800",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.