Active NPI
Amy K Miriovsky, PAC
- Physician Assistant
- Omaha, NE
National Provider Identifier
1871509075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1236
- Practice address
- 2725 South 144TH Street
Suite 212
Omaha, NE 68144 - Phone
- (402) 637-0800
- Fax
- (402) 637-0852
- NPI assigned
- Jul 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1236 | NE | Primary |
Addresses
Primary practice location
2725 South 144TH Street
Suite 212
Omaha, NE 68144
Mailing address
2725 South 144TH Street
Suite 212
Omaha, NE 68144
Phone (402) 637-0800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38630 | Other | NE | BCBS OF NEBRASKA |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1236 | NE | MD | Aerospace Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205280000000",
"number": "1871509075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2725 SOUTH 144TH STREET",
"address_2": "SUITE 212",
"city": "OMAHA",
"state": "NE",
"postal_code": "68144",
"telephone_number": "402-637-0800",
"fax_number": "402-637-0852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2725 SOUTH 144TH STREET",
"address_2": "SUITE 212",
"city": "OMAHA",
"state": "NE",
"postal_code": "68144",
"telephone_number": "402-637-0800",
"fax_number": "402-637-0852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRIOVSKY",
"first_name": "AMY",
"middle_name": "K",
"name_prefix": "Ms.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2008-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "1236",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NEBRASKA",
"identifier": "38630",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.