Individual provider Active NPI

Miranda Marie Antimo, DNAP, CRNA

  • Certified Registered Nurse Anesthetist
  • Hot Springs, AR
National Provider Identifier
1306673165
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
230495 Issued in AR
Practice address
300 Werner St
Hot Springs, AR 71913-6406
Phone
(501) 622-1000
NPI assigned
Sep 16, 2024
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 230495 AR Primary

Addresses

Primary practice location

300 Werner St
Hot Springs, AR 71913-6406

Mailing address

212 Old Stagecoach Rd
Cabot, AR 72023-7601
Phone (501) 837-2945

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241028001681 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406389550 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Youngs Professional Services LLCGroup PAC ID 2163524992, 297 clinicians

Practice addresses (Care Compare)

300 Werner St
Hot Springs, AR 71913-6406
Phone (501) 622-1930

700 W Grove St
Medical Center of South Arkansas
El Dorado, AR 71730-4416
Phone (870) 863-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
230495ARMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 4, 2024 Accepting new patients

Locations

700 W Grove St
El Dorado, AR 71730
Phone (870) 863-2200

300 Werner St
Hot Springs National Park, AR 71913
Phone (501) 622-1000

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1306673165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 OLD STAGECOACH RD",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720237601",
            "telephone_number": "501-837-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WERNER ST",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719136406",
            "telephone_number": "501-622-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTIMO",
        "first_name": "MIRANDA",
        "middle_name": "MARIE",
        "credential": "DNAP, CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "230495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hot Springs, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.