Shahram Jay Mirmanesh, MD, MBA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA05186900 Issued in NJ

Practice address

12000 Lincoln Dr W
Suite 311
Marlton, NJ 08053-3402

Phone

(856) 985-8100

Fax

(856) 985-8374

NPI assigned

May 19, 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

Medicare fee-for-service enrollment

Enrolled in NJ

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

Pediatric MedicineAlso: Family Practice

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advocare, LLCGroup PAC ID 3678562188, 383 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shahram.mirmanesh@advocaredoctors.eclinicaldirectplus.com

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.

• Advocare, LLC

  • Pediatrics Physician
  • Marlton, NJ
  • NPI 1770538696
  Medicare reassignment Care Compare group NPD
• Mirmanesh Medicine

  • Pediatrics Physician
  • Voorhees, NJ
  • NPI 1346755402
  Medicare reassignment NPD
• Unity Care Medical Group, LLC

  • Pediatrics Physician
  • Marlton, NJ
  • NPI 1528365186
  NPD (past) Authorized official
• Advocare , LLC

  dba Advocare Berlin Medical Associates (DME)

  • Internal Medicine Physician
  • Manahawkin, NJ
  • NPI 1912762162
  NPD
• Advocare , LLC

  dba Advocare Heritage Family Medicine

  • Family Medicine Physician
  • Moorestown, NJ
  • NPI 1053589515
  NPD (past)
• Center for Pediatrics Adolescent and Adult Medicine of SNJ PA

  • Pediatrics Physician
  • Marlton, NJ
  • NPI 1467508796
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750335360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 WOODBROOK RD",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080432840",
            "telephone_number": "856-768-5336",
            "fax_number": "856-985-8374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 LINCOLN DR W",
            "address_2": "SUITE 311",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533402",
            "telephone_number": "856-985-8100",
            "fax_number": "856-985-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRMANESH",
        "first_name": "SHAHRAM",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "MD, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA05186900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindful Therapy Center, LLC (Mindful Therapy)
• Mindwave Diagnostics
• Raema Mir, M.D.
• John C. Mirmanesh, M.D.
• Shahin Michael Mirmanesh, M.D.
• Shapour Steve Mirmanesh, M.D.
• Rizzalynne Rios Miro
• Daniel Peter Mirro, M.D.
• Jocelyn A Mitchell-Williams, MD
• Kristen Mitchell, BVMS

• Pediatrics Physician in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.