Individual provider Active NPI

Miranda Adanna Ewelukwa, MD

  • Dermatopathology Physician
  • Sugar Land, TX
National Provider Identifier
1174967756
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
R7918 Issued in TX
Practice address
1327 Lake Pointe Pkwy Ste 416
Sugar Land, TX 77478-3499
Phone
(281) 494-0050
NPI assigned
Apr 25, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology Physician 207ND0900X R7918 TX Primary
Dermatology Physician 207N00000X R7918 TX

Addresses

Primary practice location

1327 Lake Pointe Pkwy Ste 416
Sugar Land, TX 77478-3499

Mailing address

5310 Harvest Hill Rd Ste 290
Dallas, TX 75230-5826
Phone (214) 420-0650

Other names 1

  • Dr. Miranda Adanna Uzoma Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190125002061 TX Practitioner - Dermatology 0547486433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Texas Medical Branch at Galveston, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

1327 Lake Pointe Pkwy
Suite 416
Sugar Land, TX 77478-3499
Phone (281) 494-0050

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision16
Removal of skin lesions290
Removal or shaving of skin growth11
Skin biopsy107

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R7918TXMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oliver Street 5.01(a) Inc. Dermatology CurrentSince Nov 1, 2019 Accepting new patients

Locations

5310 Harvest Hill Rd
Ste 290
Dallas, TX 75230
Phone (214) 420-0672

1327 Lake Pointe Pkwy
Ste 416
Sugar Land, TX 77478
Phone (281) 494-0050

1367 Dominion Plz
Tyler, TX 75703
Phone (903) 534-6200

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1174967756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 HARVEST HILL RD STE 290",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752305826",
            "telephone_number": "214-420-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 LAKE POINTE PKWY STE 416",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774783499",
            "telephone_number": "281-494-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWELUKWA",
        "first_name": "MIRANDA",
        "middle_name": "ADANNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-25",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": "R7918",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "R7918",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "UZOMA",
            "middle_name": "ADANNA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sugar Land, TX

Sources for this page

Verify at the official NPI Registry.