Miracle Home Health of Wisconsin Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1174 Issued in WI

Legal business name

MIRACLE HOME HEALTH OF WISCONSIN INC

Practice address

7545 N Port Washington Rd Ste 3
Glendale, WI 53217-3422

Phone

(414) 797-2254

Fax

(888) 910-5128

NPI assigned

Mar 26, 2012

Last updated

Oct 24, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Arkadiy Kopshteyn, MBA

Title

Ceo/Owner

Phone

(414) 797-2254

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851667703. Details of each certification follow.

• CCN 527319 Home health agency · Active · Details

Home health agency certification: CCN 527319

Legal name

MIRACLE HOME HEALTH OF WISCONSIN INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 25, 2014

Last certification

Nov 25, 2014

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Mar 11, 2012 in WI

Enrollment address

7545 N Port Washington Rd
Stop 3
Glendale, WI 53217-3422

Listed as

Miracle Home Health of WisconsinCCN 527319 · All quality measures

Overall star rating

2 of 5

Ownership

Proprietary

Certified

Nov 25, 2014

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michelle Keating, DPT

  • Geriatric Physical Therapist
  • Wauwatosa, WI
  • NPI 1003365313

  Geriatrics

  NPD

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1851667703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7545 N PORT WASHINGTON RD STE 3",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173422",
            "telephone_number": "414-915-0838",
            "fax_number": "414-797-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7545 N PORT WASHINGTON RD STE 3",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173422",
            "telephone_number": "414-797-2254",
            "fax_number": "888-910-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE HOME HEALTH OF WISCONSIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-26",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "KOPSHTEYN",
        "authorized_official_first_name": "ARKADIY",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "414-797-2254",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WI",
            "license": "1174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100039227",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marisa K Miller
• Milwaukee Family Chiropractic
• Milwaukee Occupational Medicine SC
• Catherine C Mingo, MD
• Miracle Beginnings LLC
• Mobile Physician Clinics, LLC
• Alexandra Modell, L.AC.
• Patricia Ann Modell, LCSW
• Stephen David Moerschel, APNP
• Aweis Jeilani Mohamed

• Home Health Agency in Glendale, WI
• Providers in Glendale, WI by specialty
• Home Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.