NPIMap

Individual provider Active NPI

Max Miranda, M.D.

  • Gastroenterology Physician
  • Duluth, MN
National Provider Identifier
1225259567
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
53106 Issued in MN
Practice address
1012 E 2ND St
Duluth, MN 55805-2200
Phone
(218) 249-7940
Fax
(218) 249-7949
NPI assigned
May 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 53106 MN Primary

Addresses

Primary practice location

1012 E 2ND St
Duluth, MN 55805-2200

Mailing address

1012 E 2ND St
Duluth, MN 55805-2200
Phone (218) 249-7940

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@slk.direct.slhduluth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20101217000094 MN Practitioner - GastroenterologyPractitioner - Internal Medicine 6204024219 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Hawaii John a. Burns School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke'S Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047
  • Aspirus Lake View Hospital Hospital, Two Harbors, MN, CCN 241308
  • Community Memorial Hospital Hospital, Cloquet, MN, CCN 241364

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy101
Upper gastrointestinal (GI) endoscopy for acid reflux209

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Riverview Healthcare Association Current Accepting new patients
St. Luke'S Hospital of Duluth Gastroenterology CurrentSince Sep 1, 2010 Accepting new patients
St. Luke'S Hospital of Duluth Current Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Sep 1, 2010 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

323 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9200

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

Interoperability endpoints

  • Direct secure messaging: mmiranda237514@direct.aspirus.org

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 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1225259567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052200",
            "telephone_number": "218-249-7940",
            "fax_number": "218-249-7949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052200",
            "telephone_number": "218-249-7940",
            "fax_number": "218-249-7949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "MAX",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "53106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "1012 E 2nd St",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558052200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.