Individual provider Active NPI

Miranda Brooke Pratt, PA

  • Physician Assistant
  • Knoxville, TN
National Provider Identifier
1255906301
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4355 Issued in TN
Practice address
1300 Old Weisgarber Rd
Knoxville, TN 37909-1291
Phone
(865) 584-2146
Fax
(865) 500-6436
NPI assigned
May 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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 4355 TN Primary

Addresses

Primary practice location

1300 Old Weisgarber Rd
Knoxville, TN 37909-1291

Mailing address

2166 E Broadway Ave
Maryville, TN 37804-3035
Phone (865) 273-9024

Other identifiers 1

IdentifierTypeStateIssuer
Q066090MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pratt.miranda.brooke@covenanthealth.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210528000426 TN Practitioner - Physician Assistant 2163821893 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Group IncGroup PAC ID 2860305463, 363 clinicians

Practice addresses (Care Compare)

111 Clyde St
Loudon, TN 37774-1600
Phone (865) 458-1554

1300 Old Weisgarber Rd
Knoxville, TN 37909-1291
Phone (865) 584-2146

1320 Old Weisgarber Rd
Knoxville, TN 37909-1291
Phone (865) 584-1054

6600 Nightingale LN
Knoxville, TN 37909-2754
Phone (865) 632-5885

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4355TNMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince May 3, 2021 Accepting new patients
Covenant Medical Group, Inc CurrentSince Aug 1, 2022 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince May 3, 2021 Accepting new patients
Covenant Medical Group, Inc. Physician Assistant CurrentSince Aug 1, 2022 Accepting new patients

Locations

7056 Oak Ridge Hwy
Knoxville, TN 37931

Dept 888179
Knoxville, TN 37995

1300 Old Weisgarber Rd
Knoxville, TN 37909
Phone (865) 584-2146

111 Clyde St
Loudon, TN 37774
Phone (865) 458-1554

2166 E Broadway Ave
Maryville, TN 37804
Phone (865) 273-9024

Interoperability endpoints

  • Direct secure messaging: pratt.miranda.brooke@covenanthealth.cernerdirect.com

Organizations & group practices 4

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": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1255906301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2166 E BROADWAY AVE",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378043035",
            "telephone_number": "865-273-9024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 OLD WEISGARBER RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091291",
            "telephone_number": "865-584-2146",
            "fax_number": "865-500-6436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATT",
        "first_name": "MIRANDA",
        "middle_name": "BROOKE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "4355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q066090",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pratt.miranda.brooke@covenanthealth.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1300 Old Weisgarber Rd",
            "city": "Knoxville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "379091291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.