NPIMap

Individual provider Active NPI

Mir Ismail Quryshi, MD

  • Internal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1871506089
Registry record updated Nov 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
41688 Issued in WI
Practice address
840 N 87TH St
Milwaukee, WI 53226-3586
Phone
(414) 805-5540
Fax
(414) 805-7878
NPI assigned
Aug 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 41688-20 WI
Internal Medicine Physician 207R00000X 41688 WI Primary

Addresses

Primary practice location

840 N 87TH St
Milwaukee, WI 53226-3586

Mailing address

840 N 87TH St
Milwaukee, WI 53226-3586
Phone (414) 805-5540

Other practice location 1

6200 W Bluemound Rd
Milwaukee, WI 53213-4145
Phone (414) 771-5600

Other identifiers 1

IdentifierTypeStateIssuer
34006800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20070302000048 WI Practitioner - Internal Medicine 1557463056 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1155 N Mayfair Rd
Wauwatosa, WI 53226-3462
Phone (414) 955-5990

840 N 87TH St
Milwaukee, WI 53226-3586
Phone (414) 805-5540

W168N11237 Western Ave
Germantown, WI 53022-3239
Phone (262) 253-5060

Hospital & facility affiliations

  • St. Camillus Home Health Agency Home health agency, Wauwatosa, WI, CCN 527164
  • Horizon Home Care and Hospice Home health agency, Milwaukee, WI, CCN 527083
  • Aurora at Home Home health agency, Milwaukee, WI, CCN 527001
  • St Camillus Hospice Hospice, Wauwatosa, WI, CCN 521588
  • Luther Manor Hospice Hospice, Wauwatosa, WI, CCN 521585
  • Horizon Homecare and Hospice Hospice, Milwaukee, WI, CCN 521531
  • Commonheart Hospice Hospice, Waukesha, WI, CCN 521578
  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177
  • St Camillus Health Center Nursing home, Wauwatosa, WI, CCN 525382
  • Luther Manor Nursing home, Milwaukee, WI, CCN 525588
  • Lindengrove Menomonee Falls Nursing home, Menomonee Falls, WI, CCN 525421

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41688WIMDInternal Medicine Physician
41688-20WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Internal Medicine CurrentSince Jun 2, 2018 Accepting new patients
The Medical College of Wisconsin, Inc. Internal Medicine CurrentSince May 8, 2018 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jun 2, 2018 Accepting new patients
Wisconsin Health Fund Past Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

6200 W Bluemound Rd
Milwaukee, WI 53213
Phone (414) 479-3668

1155 Quail Ct
Pewaukee, WI 53072
Phone (262) 746-6950

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540

4545 N 92nd St
Wauwatosa, WI 53225
Phone (414) 464-3880

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Interoperability endpoints

  • Direct secure messaging: iquryshimd253969@direct.froedtert.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lindengrove Menomonee FallsMenomonee Falls, WI, CCN 525421 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2020
Jun 1, 2020
Luther Manor HospiceWauwatosa, WI, CCN 521585 Hospice Contracted Managing Employee Jul 8, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1871506089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 N 87TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263586",
            "telephone_number": "414-805-5540",
            "fax_number": "414-805-7878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N 87TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263586",
            "telephone_number": "414-805-5540",
            "fax_number": "414-805-7878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6200 W Bluemound Rd",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532134145",
            "country_code": "US",
            "telephone_number": "414-771-5600",
            "fax_number": "414-431-0140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QURYSHI",
        "first_name": "MIR",
        "middle_name": "ISMAIL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "41688-20",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "41688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34006800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.