Individual provider Active NPI

Miranda Elizabeth Rose, M.D.

  • Family Medicine Physician
  • Dublin, OH
National Provider Identifier
1215357991
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30017 Issued in WV
Practice address
545 Metro PL S Ste 100
Dublin, OH 43017-5353
Phone
(415) 671-2165
NPI assigned
Apr 22, 2014
Last updated
Mar 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 35129488 OH
Family Medicine Physician 207Q00000X 30017 WV Primary

Addresses

Primary practice location

545 Metro PL S Ste 100
Dublin, OH 43017-5353

Mailing address

545 Metro PL S Ste 100
Dublin, OH 43017-5353
Phone (415) 671-2165

Other identifiers 1

IdentifierTypeStateIssuer
H609640OtherMEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address miranda.rose@marshall.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, WV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170920002507 OH Practitioner - Family Practice 9537433123 Reassigns benefits to 1 organization
I20220525002251 WV Practitioner - Family Practice 9537433123 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35129488OHMDFamily Medicine Physician
30017WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians & Surgeons, Inc. CurrentSince Jan 8, 2024 Accepting new patients
Ohio Physician Professional Corporation Single Specialty CurrentSince Apr 13, 2020 Accepting new patients
University Physicians & Surgeons, Inc Single Specialty CurrentSince Jan 8, 2024 Accepting new patients

Locations

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

2606 Wales Ave NW
Ste 300
Massillon, OH 44646
Phone (330) 834-1111

6100 Whipple Ave NW
North Canton, OH 44720
Phone (330) 305-6999

1448 10th Ave
Ste 304
Huntington, WV 25701
Phone (304) 691-6381

1600 Medical Center Dr
Ste 1500
Huntington, WV 25701
Phone (304) 691-1100

1600 Medical Center Dr
Ste 3500
Huntington, WV 25701
Phone (304) 691-1300

Interoperability endpoints

  • Direct secure messaging: miranda.rose@marshall.cernerdirect.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1215357991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 METRO PL S STE 100",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430175353",
            "telephone_number": "415-671-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 METRO PL S STE 100",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430175353",
            "telephone_number": "415-671-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "MIRANDA",
        "middle_name": "ELIZABETH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-22",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35129488",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "30017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "H609640",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "miranda.rose@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1600 Medical Center Dr Ste 1500",
            "city": "Huntington",
            "state": "WV",
            "country_code": "US",
            "postal_code": "257013657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dublin, OH

Sources for this page

Verify at the official NPI Registry.