Kenneth Victor Miselis, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

00G502810 Issued in CA

Practice address

445 W Poplar St
Stockton, CA 95203-2426

Phone

(209) 465-5933

Fax

(209) 465-2562

NPI assigned

Feb 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

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

Ophthalmology

Education

University of Vermont College of Medicine, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Valley Eye Medical Group IncGroup PAC ID 8729178843, 10 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

24.71 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

82.37

Merit-based Incentive Payment System (MIPS)

Final score

94.48 of 100Reported as group

Quality

100

Improvement activities

40

Cost

73.39

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kmiselis16411@hpmg.direct-ci.net

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.

• Central Valley Eye Medical Group Inc.

  • Ophthalmology Physician
  • Stockton, CA
  • NPI 1609975366
  Medicare reassignment Care Compare group NPD
• Heritage Eye Associates

  • Durable Medical Equipment & Medical Supplies
  • Stockton, CA
  • NPI 1972636397
  NPD (past) Authorized official
• Hill Physicians Medical Group - PPO Program

  • Preferred Provider Organization
  • San Ramon, CA
  • NPI 1679011035
  NPD (past)

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237766400000",
    "number": "1730154592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 W POPLAR ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952032426",
            "telephone_number": "209-465-5933",
            "fax_number": "209-465-2562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 W POPLAR ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952032426",
            "telephone_number": "209-465-5933",
            "fax_number": "209-465-2562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISELIS",
        "first_name": "KENNETH",
        "middle_name": "VICTOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2009-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "00G502810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180033368",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMERC",
            "identifier": "0761830001",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0050600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dorothy Miro
• Miroslav Djokic M.D. Inc.
• Aida Mirzaei
• Enamulhaq Mirzay, COTA
• Yura Misakyan
• Jessica Mitchell-Castro
• Alicia Mitchell
• Amber Marie Mitchell
• Brittany Shirmae Star Mitchell
• Elizabeth M. Mitchell, FNP-C

• Specialist in Stockton, CA
• Providers in Stockton, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; 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.