Miranda Anne Goodale, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

07001015A Issued in IN

Practice address

955 W Craig Ave
Brazil, IN 47834-7400

Phone

(812) 448-9290

Fax

(812) 448-9296

NPI assigned

Jun 10, 2006

Last updated

May 31, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

William M. Scholl College of Podiatric Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Clay Hospital, Brazil, IN, CCN 151309

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

99.59

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: mgoodale@ccpl-in.direct.office.nextgen.com

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.

• Clay County Podiatry, LLC

  • Foot & Ankle Surgery Podiatrist
  • Brazil, IN
  • NPI 1972532125

  Primary Podiatric Medicine

  Medicare reassignment NPD Authorized official
• Russell Harms DPM PC

  • Foot & Ankle Surgery Podiatrist
  • Brazil, IN
  • NPI 1114162435
  NPD (past)

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

• St. Vincent Clay Hospital, Inc

  • Critical Access Hospital
  • Brazil, IN
  • NPI 1770533994
  Care Compare affiliation

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559260800000",
    "number": "1003858762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 W CRAIG AVE",
            "city": "BRAZIL",
            "state": "IN",
            "postal_code": "478347400",
            "telephone_number": "812-448-9290",
            "fax_number": "812-448-9296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W CRAIG AVE",
            "city": "BRAZIL",
            "state": "IN",
            "postal_code": "478347400",
            "telephone_number": "812-448-9290",
            "fax_number": "812-448-9296"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1214 E National Ave",
            "address_2": "Suite 130",
            "address_purpose": "LOCATION",
            "city": "Brazil",
            "state": "IN",
            "postal_code": "478342700",
            "country_code": "US",
            "telephone_number": "812-448-9290",
            "fax_number": "812-448-9296",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODALE",
        "first_name": "MIRANDA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2019-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "IN",
            "license": "07001015A",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IN",
            "license": "07001015A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200825350A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHN PPO NETWORK",
            "identifier": "37278",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC WITH PPG",
            "identifier": "0732240001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0385202",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000392910",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTHEALTH",
            "identifier": "5692086",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcy Gardner, NP
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• Elizabeth Gilbert, PHARM.D.
• Sierra Kay Girton, RD
• Erin Jenelle Graves, MASTERS DEGREE
• David Guenther
• Guidance Pediatrics and Autism Services LLC
• Marcelyn Jay Hagan, RPH
• Adrienne Ann Hagedorn, D.C

• Foot & Ankle Surgery Podiatrist in Brazil, IN
• Providers in Brazil, IN by specialty
• Foot & Ankle Surgery Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; 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.