Lisa M Miranda, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA15570 Issued in CA

Practice address

568 N Sunrise Ave Ste 250
Roseville, CA 95661

Phone

(916) 865-1140

NPI assigned

Oct 3, 2006

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 7

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Care at Home Home health agency, Roseville, CA, CCN 057545
• Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309
• Sutter Medical Center, Sacramento Hospital, Sacramento, CA, CCN 050108

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lmirandapac39414@hisp.ehr.sutterhealth.org

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.

• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment Care Compare group NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Sutter North Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)

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

• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Roseville, CA
  • NPI 1356390264
  Care Compare affiliation
• Sutter Valley Hospitals

  • General Acute Care Hospital
  • Sacramento, CA
  • NPI 1811946734
  Care Compare affiliation
• Sutter Visiting Nurse Association and Hospice

  • Home Health Agency
  • Roseville, CA
  • NPI 1770512535
  Care Compare affiliation

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1144314766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 N SUNRISE AVE STE 250",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "95661",
            "telephone_number": "916-865-1140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2121 NORTH OCOEE STREET",
            "address_2": "SUITE 101",
            "address_purpose": "LOCATION",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "37311",
            "country_code": "US",
            "telephone_number": "423-472-6548",
            "fax_number": "423-472-8318",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2121 NORTH OCOEE STREET",
            "address_2": "SUITE 101",
            "address_purpose": "LOCATION",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "37311",
            "country_code": "US",
            "telephone_number": "423-472-6548",
            "fax_number": "423-472-8318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "LISA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA1051",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970027904",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "2000307",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN0102",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3661837",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0140208",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "621038898",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMP",
            "identifier": "FP62706",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Lyn Milotz, PSY.D.
• Alizon Edith Minjarez Romero
• Brett Jordan Minkin, R.R.T., N.P.S.
• Rose Minton
• Christel Dizon Miranda, MD
• Melissa Miranda
• Lucia Mireles
• Hossein Mirheydar, M.D.
• Phillip Alan Mishaga, IDC
• Naveen Mishra, D.O.

• Physician Assistant in Roseville, CA
• Providers in Roseville, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.