NPIMap

Individual provider Active NPI

Miranda Dawn Wood, PA

  • Physician Assistant
  • Columbia, TN
National Provider Identifier
1184751745
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1592 Issued in TN
Practice address
1222 Trotwood Ave
Suite 108
Columbia, TN 38401-6436
Phone
(931) 540-4140
Fax
(931) 540-4142
NPI assigned
Feb 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1592 TN Primary

Addresses

Primary practice location

1222 Trotwood Ave
Suite 108
Columbia, TN 38401-6436

Mailing address

854 W James Campbell Blvd
Suite 303
Columbia, TN 38401-4659
Phone (931) 540-4140

Other identifiers 3

IdentifierTypeStateIssuer
1505712MedicaidTN
4191519OtherBCBST
3710089MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080718000462 TN Practitioner - Physician Assistant 3375616626 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Maury Regional HospitalGroup PAC ID 4688569718, 31 clinicians

Practice addresses (Care Compare)

1222 Trotwood Ave
Suite 108
Columbia, TN 38401-6404
Phone (931) 540-4140

617 W Main St
Hohenwald, TN 38462-1355
Phone (931) 796-4901

854 W James Campbell Blvd
Suite 303
Columbia, TN 38401-4659

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1592TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Maury Regional Medical Group, Inc Physician Assistant CurrentSince Jul 14, 2008 Accepting new patients
Maury Regional Hospital Current Accepting new patients
Maury Regional Hospital Marshall Medical Center CurrentSince Jul 14, 2008 Accepting new patients
Maury Regional Hospital CurrentSince Oct 4, 2015 Accepting new patients
Maury Regional Hospital Past Accepting new patients

Locations

1218 Trotwood Ave
Columbia, TN 38401
Phone (931) 380-4114

854 W James M Campbell Blvd
Ste 303
Columbia, TN 38401
Phone (931) 388-8779

854 W James M Campbell Blvd
Ste 301
Columbia, TN 38401
Phone (931) 388-8779

1222 Trotwood Ave
Ste 108
Columbia, TN 38401
Phone (931) 380-4066

1222 Trotwood Ave
Ste 101
Columbia, TN 38401
Phone (931) 490-7348

617 W Main St
Hohenwald, TN 38462
Phone (931) 796-4901

103 Jv Mangubat Dr
Waynesboro, TN 38485
Phone (931) 722-3404

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1184751745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "854 W JAMES CAMPBELL BLVD",
            "address_2": "SUITE 303",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384014659",
            "telephone_number": "931-540-4140",
            "fax_number": "931-540-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 TROTWOOD AVE",
            "address_2": "SUITE 108",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384016436",
            "telephone_number": "931-540-4140",
            "fax_number": "931-540-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "MIRANDA",
        "middle_name": "DAWN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2015-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1505712",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4191519",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3710089",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, TN

Sources for this page

Verify at the official NPI Registry.