Individual provider Active NPI

Morgan Mirth

  • Pediatric Nurse Practitioner
  • Dublin, CA
National Provider Identifier
1740605443
Registry record updated Sep 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
NP95010966 Issued in CA
Practice address
4050 Dublin Blvd
Dublin, CA 94568-3112
Phone
(925) 875-6100
NPI assigned
Mar 4, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 202684 MD
Pediatric Nurse Practitioner 363LP0200X RN654575 PA
Pediatric Nurse Practitioner 363LP0200X NP95010966 CA Primary

Addresses

Primary practice location

4050 Dublin Blvd
Dublin, CA 94568-3112

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (925) 875-6100

Other practice location 1

2315 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2011

Other practice location 2

2315 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95010966CAMDPediatric Nurse Practitioner
202684MDMDPediatric Nurse Practitioner
RN654575PAMDPediatric Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1740605443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "925-875-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 DUBLIN BLVD",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945683112",
            "telephone_number": "925-875-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2315 Stockton Blvd",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "95817",
            "country_code": "US",
            "telephone_number": "916-734-2011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2315 Stockton Blvd",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "95817",
            "country_code": "US",
            "telephone_number": "916-734-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRTH",
        "first_name": "MORGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-04",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "202684",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "PA",
            "license": "RN654575",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "NP95010966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.