Kenneth R Mirkin, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

0101036056 Issued in VA

Practice address

3028 Javier Rd Ste 500
Fairfax, VA 22031

Phone

(703) 698-8960

Fax

(571) 494-5794

NPI assigned

Jan 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in DC, SC2 enrollments

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 2

Specialty

Gastroenterology

Education

Wayne State University School of Medicine, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Novant Health Hilton Head Medical Center Hospital, Hilton Head Island, SC, CCN 420080

Merit-based Incentive Payment System (MIPS)

Final score

80.52 of 100Reported as group

Quality

56.13

Promoting interoperability

98

Improvement activities

40

Cost

80.61

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gastroenterology Associates of Northern Virginia, LLC

  • Gastroenterology Physician
  • Fairfax, VA
  • NPI 1205884368

  DC

  Medicare reassignment NPD
• Old Dominion Anesthesia LLC

  • Anesthesiology Physician
  • Charlottesville, VA
  • NPI 1902248677
  NPD (past)
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

• Hilton Head Medical Center LLC

  dba Novant Health Hilton Head Medical Center

  • General Acute Care Hospital
  • Hilton Head Island, SC
  • NPI 1902675101
  Care Compare affiliation

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1952372542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 JOSEPH SIEWICK DR STE 308",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331739",
            "telephone_number": "703-698-8960",
            "fax_number": "703-716-8703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3028 JAVIER RD STE 500",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-698-8960",
            "fax_number": "571-494-5794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3022 Williams Dr",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314600",
            "country_code": "US",
            "telephone_number": "703-698-1775",
            "fax_number": "703-641-8427",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3700 Joseph Siewick Dr Ste 308",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220331739",
            "country_code": "US",
            "telephone_number": "703-698-8960",
            "fax_number": "647-646-4744",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3914 Centreville Rd Ste 350",
            "address_purpose": "LOCATION",
            "city": "Chantilly",
            "state": "VA",
            "postal_code": "201513289",
            "country_code": "US",
            "telephone_number": "703-716-8700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Elden St Ste 10",
            "address_purpose": "LOCATION",
            "city": "Herndon",
            "state": "VA",
            "postal_code": "201704833",
            "country_code": "US",
            "telephone_number": "703-698-8960",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Kings Way Ste 3500",
            "address_purpose": "LOCATION",
            "city": "Williamsburg",
            "state": "VA",
            "postal_code": "231852511",
            "country_code": "US",
            "telephone_number": "757-221-0750",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "850 Enterprise Pkwy Ste 2000",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236666252",
            "country_code": "US",
            "telephone_number": "757-599-6333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRKIN",
        "first_name": "KENNETH",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VA",
            "license": "0101036056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "187598",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "341902",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "336682",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100010309",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "231620",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6096026",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "178732",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "79160004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "740013",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandra Nicole Minutillo
• Mira Genetix
• Heather Miranda
• Kierstin Mireku
• Ahmadshah Mirkhel, M.D.
• Fatima Mirza, PHD, LCSW
• Sohail K Mirza, M.D., M.P.H.
• Sulman A Mirza, M.D.
• Alina Mirzayan
• Arun P Mishra

• Gastroenterology Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Gastroenterology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.