NPIMap

Individual provider Active NPI

Vijay Mirmira, M.D

  • Family Medicine Physician
  • Lodi, CA
National Provider Identifier
1851577241
Registry record updated Feb 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A106428 Issued in CA
Practice address
1901 W Kettleman LN
Suite 200
Lodi, CA 95242-4337
Phone
(209) 334-8540
Fax
(209) 368-2885
NPI assigned
Jan 15, 2008
Last updated
Feb 26, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A106428 CA Primary

Addresses

Primary practice location

1901 W Kettleman LN
Suite 200
Lodi, CA 95242-4337

Mailing address

PO Box 241011
Lodi, CA 95241-9511
Phone (209) 339-7825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090708000245 CA Practitioner - Family Practice 7113098799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

1300 Crane St
Menlo Park, CA 94025-4260
Phone (650) 498-6500

4725 1St St
Suite 100
Pleasanton, CA 94566-7366
Phone (925) 462-7060

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions27
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
University Healthcare Alliance CurrentSince May 1, 2013 Accepting new patients
Lodi Memorial Hospital Association Inc Past Accepting new patients
St Marys Hospital Decatur of the Hospital Sisters of the Third Order Past Accepting new patients
Alameda Health System Past Accepting new patients
Affinity Medical Group Past Accepting new patients

Locations

2433 Central Ave
Ste A
Alameda, CA 94501
Phone (510) 521-2300

50 E Hamilton Ave
Ste 280
Campbell, CA 95008
Phone (408) 227-2646

27212 Calaroga Ave
Hayward, CA 94545
Phone (510) 783-5532

1300 Crane St
Menlo Park, CA 94025
Phone (510) 785-5000

4725 1st St
Ste 100
Pleasanton, CA 94566
Phone (925) 462-7060

Interoperability endpoints

  • Direct secure messaging: vmirmira77966@direct.stanfordhealthcare.org

Organizations & group practices 5

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361836800000",
    "number": "1851577241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 241011",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952419511",
            "telephone_number": "209-339-7825",
            "fax_number": "209-339-7528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 W KETTLEMAN LN",
            "address_2": "SUITE 200",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952424337",
            "telephone_number": "209-334-8540",
            "fax_number": "209-368-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRMIRA",
        "first_name": "VIJAY",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-15",
        "last_updated": "2013-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A106428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.