Individual provider Active NPI

Joseph N Mirkovich Jr., M.D.

  • Psychiatry Physician
  • Rosemead, CA
National Provider Identifier
1891761623
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
77930 Issued in CA
Practice address
7500 Hellman Ave
Rosemead, CA 91770-2216
Phone
(626) 288-1160
Fax
(626) 371-1320
NPI assigned
Feb 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 39185 TN
Psychiatry Physician 2084P0800X A77930 CA
Psychiatry Physician 2084P0800X 77930 CA Primary

Addresses

Primary practice location

7500 Hellman Ave
Rosemead, CA 91770-2216

Mailing address

6521 Via Lorenzo
Rancho Palos Verdes, CA 90275-6543
Phone (323) 842-2658

Other identifiers 1

IdentifierTypeStateIssuer
00A779300MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20090724000562 CA Practitioner - Psychiatry 7113070053 Reassigns benefits to 1 organization
Practice locations: Los Angeles, CA; Rosemead, CA; San Pedro, CA

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Southern California Keck School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Department of State HospitalsGroup PAC ID 9638174238, 275 clinicians

Practice addresses (Care Compare)

11401 Bloomfield Ave
Norwalk, CA 90650-2015
Phone (916) 651-8811

Hospital & facility affiliations

  • Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485
  • St Mary Medical Center Hospital, Long Beach, CA, CCN 050191

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
77930CAMDPharmacist
39185TNMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals CurrentSince Jul 1, 2015 Accepting new patients
Department of State Hospitals CurrentSince Jul 1, 2015 Accepting new patients
Department of State Hospitals Current Accepting new patients

Locations

11401 Bloomfield Ave
Norwalk, CA 90650
Phone (562) 863-7011

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

Organizations & group practices 3

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 2

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1891761623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6521 VIA LORENZO",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902756543",
            "telephone_number": "323-842-2658",
            "fax_number": "888-235-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 HELLMAN AVE",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917702216",
            "telephone_number": "626-288-1160",
            "fax_number": "626-371-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRKOVICH",
        "first_name": "JOSEPH",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "39185",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A77930",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "77930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A779300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rosemead, CA

Sources for this page

Verify at the official NPI Registry.