Mohammed Azher Mirza, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

R1C10 Issued in MO

Practice address

4045 NE Lakewood Way
Ste 130
Lees Summit, MO 64064-1995

Phone

(816) 228-5335

Fax

(816) 228-7663

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• M a Mirza Other name

Medicare fee-for-service enrollment

Enrolled in MO

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

Psychiatry

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

M a Mirza LLCGroup PAC ID 4284865056, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: whiteoakpsychiatricservices.mohammedmirza@133176.advancedmd-direct.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.

• M a Mirza, LLC

  • Prescribing (Medical) Psychologist
  • Lees Summit, MO
  • NPI 1376757617
  Medicare reassignment Care Compare group Authorized official
• Kansas City Psychiatric Consultants, Inc

  • Psychiatric Hospital Unit
  • Kansas City, MO
  • NPI 1407167661
  NPD (past)
• Ravinder Goswami LLC

  • Psychologist
  • Blue Springs, MO
  • NPI 1609121912
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1710067822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 NE LAKEWOOD WAY",
            "address_2": "STE 130",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641995",
            "telephone_number": "816-228-5335",
            "fax_number": "816-228-7663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 NE LAKEWOOD WAY",
            "address_2": "STE 130",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640641995",
            "telephone_number": "816-228-5335",
            "fax_number": "816-228-7663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "MOHAMMED",
        "middle_name": "AZHER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "R1C10",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "MA4861001",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KC",
            "identifier": "10731160",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H201651387",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "0006543B",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "100419680A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "M A",
            "last_name": "MIRZA",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Psychiatry Physician in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.