NPIMap

Individual provider Active NPI

Juan Camilo Mira, M.D.

  • Surgery Physician
  • Des Moines, IA
National Provider Identifier
1902245806
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD-49649 Issued in IA
Practice address
1212 Pleasant St Ste 211
Des Moines, IA 50309-1411
Phone
(515) 875-9770
Fax
(515) 875-9771
NPI assigned
Jun 24, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 19092 FL
Surgery Physician 208600000X MD-49649 IA Primary

Addresses

Primary practice location

1212 Pleasant St Ste 211
Des Moines, IA 50309-1411

Mailing address

PO Box 424
Des Moines, IA 50302-0424
Phone (515) 875-9255

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address juanmira@tic.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20220805000326 IA Practitioner - Surgical OncologyPractitioner - General Surgery 0345475869 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Surgical OncologyAlso: General Surgery
Education
University of Michigan Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Iowa Clinic PCGroup PAC ID 4082513742, 307 clinicians

Practice addresses (Care Compare)

1212 Pleasant St
Suite 211
Des Moines, IA 50309-1411
Phone (515) 875-9100

Hospital & facility affiliations

  • Unitypoint Health - Des Moines Iowa Methodist Medi Hospital, Des Moines, IA, CCN 160082
  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083
  • Greater Regional Medical Center Hospital, Creston, IA, CCN 161365

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision58
Removal of tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19092FLMDMental Health Counselor
MD-49649IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Iowa Clinic PC Surgery CurrentSince Aug 17, 2022 Accepting new patients
The Iowa Clinic, PC CurrentSince Aug 17, 2022 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Central Iowa Hospital Corporation Past Accepting new patients

Locations

1212 Pleasant St
Ste 211
Des Moines, IA 50309
Phone (515) 875-9770

1005 Pennsylvania Ave
Ste 102A
Ottumwa, IA 52501
Phone (641) 684-2589

5950 University Ave
Ste 321
West Des Moines, IA 50266
Phone (515) 875-9178

Interoperability endpoints

  • Direct secure messaging: jmira910811@direct.unitypoint.org
  • Direct secure messaging: juanmira@tic.allscriptsdirect.net

Organizations & group practices 4

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 8

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": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1902245806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 424",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503020424",
            "telephone_number": "515-875-9255",
            "fax_number": "515-875-9223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 PLEASANT ST STE 211",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503091411",
            "telephone_number": "515-875-9770",
            "fax_number": "515-875-9771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRA",
        "first_name": "JUAN",
        "middle_name": "CAMILO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-24",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "19092",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "MD-49649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "juanmira@tic.allscriptsdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1212 Pleasant St Ste 211",
            "city": "Des Moines",
            "state": "IA",
            "country_code": "US",
            "postal_code": "503091411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.