Anthony Loren Miranda, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C165064 Issued in CA

Practice address

239 Stony Brook Cir
Jackson, GA 30233-4571

Phone

(209) 306-4796

Fax

(478) 247-8448

NPI assigned

Jun 6, 2008

Last updated

Nov 21, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, CA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment NPD
• Circle Medical Care of California

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1134596091

  Internal Medicine

  Medicare reassignment NPD
• Regents of the University of California

  dba UC Davis Medical Group

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1952998973
  Medicare reassignment NPD
• Oconee Valley Healthcare Inc

  • Federally Qualified Health Center (FQHC)
  • Greensboro, GA
  • NPI 1255433736
  NPD
• Regents of the University of California

  • Multi-Specialty Clinic/Center
  • Davis, CA
  • NPI 1912987553
  NPD
• Effingham Hospital, Inc.

  dba Effingham Ear Nose and Throat

  • Otolaryngology Physician
  • Springfield, GA
  • NPI 1881588028
  NPD (past)

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1245499078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2660 W COVELL BLVD",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165645",
            "telephone_number": "530-747-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 STONY BROOK CIR",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302334571",
            "telephone_number": "209-306-4796",
            "fax_number": "478-247-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "ANTHONY",
        "middle_name": "LOREN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "070199",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "TPME1727",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C165064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer McElhannon, OCCUPATIONAL THERAPI
• McIntosh Trail Community Service Board
• McIntosh Trail Community Service Board
• McIntosh Trail CSB (Butts Co DD Center)
• Kayla Merritt, FNP-C
• Jennifer Monsrud, NP
• Narico Carnod Moore Jr.
• Valaire Latrisha Moore
• Jorge Luis Moreno Sr., M.D.
• Jorge Luis Moreno Jr., M.D.

• Internal Medicine Physician in Jackson, GA
• Providers in Jackson, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.