Miranda McCormack, M.D., LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

465592-90 Issued in OR

Legal business name

MIRANDA MCCORMACK, M.D., LLC

Practice address

5040 SW Griffith Dr
#201
Beaverton, OR 97005-2985

Phone

(503) 616-2224

NPI assigned

Feb 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Miranda Christie McCormack, M.D.NPI 1356397871

Title

Physician/Owner

Phone

(503) 616-2224

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miranda C McCormack, MD

  • Family Medicine Physician
  • Beaverton, OR
  • NPI 1356397871

  OR

  Medicare reassignment NPD Authorized official
• Alexander Chan Yu, MD, PHD

  • Allergy & Immunology Physician
  • Beaverton, OR
  • NPI 1760614283
  NPD

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1043488166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5040 SW GRIFFITH DR",
            "address_2": "#201",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052985",
            "telephone_number": "503-616-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5040 SW GRIFFITH DR",
            "address_2": "#201",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052985",
            "telephone_number": "503-616-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRANDA MCCORMACK, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-11",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "MCCORMACK",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_middle_name": "CHRISTIE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "503-616-2224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "465592-90",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth M Minick, MSW
• D'Nise Michele Minor, LMT
• Laura Minthorne, OTD, OTR/L
• Mir Clinic, P.C.
• Jared Miracle, PA-C
• Elisa Miranda
• Mehdi M Mirtorabi, MD
• Terri Lynn Mishler, PSYD
• Elizabeth Misner
• Katharine Theresa Mitchell, FNP

• All providers in Beaverton, OR
• Primary Care Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.