Kenyatta Mireku, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

080834 Issued in GA

Practice address

771 Old Norcross Rd Ste 260
Lawrenceville, GA 30046-4981

Phone

(770) 962-5040

Fax

(770) 962-5056

NPI assigned

Apr 24, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Dermatology

Education

Medical College of Georgia School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of Georgia, LLCGroup PAC ID 9638485782, 15 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

94.02 of 100Reported as group

Quality

88.03

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Advanced Dermatology of Georgia, LLC

  • Dermatology Physician
  • Albany, GA
  • NPI 1184005068
  Medicare reassignment Care Compare group NPD
• North Georgia Dermatology, P.C.

  • Dermatology Physician
  • Lawrenceville, GA
  • NPI 1154483139
  NPD

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

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1740600048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD STE 260",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464981",
            "telephone_number": "770-962-5040",
            "fax_number": "770-962-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIREKU",
        "first_name": "KENYATTA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-24",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "080834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Minding My Health Solutions LLC
• Carolyn M Minor, LCSW
• Makeda Minott
• Opal Hope Minott, LCSW
• Mira Chiropractic Clinic, LLC
• Mirror Image Group, LLC
• Mission Point Hospice LLC
• Hunaiza Mistry, NP
• Monisha Mistry, DO
• Brandie Renee Mitchell

• Dermatology Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; 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.