Miran Joelle Song, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

49275 Issued in AZ

Practice address

2920 N 4TH St
Flagstaff, AZ 86004-1816

Phone

(928) 522-9400

Fax

(928) 774-4808

NPI assigned

Feb 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX, AZ2 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

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 and National Provider Directory roles.

• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1548294424

  TX

  Medicare reassignment
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1073583472
  NPD
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Show Low, AZ
  • NPI 1073740098
  NPD
• North Country Healthcare, Inc.

  • Family Medicine Physician
  • Flagstaff, AZ
  • NPI 1619345675
  NPD
• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Bullhead, AZ
  • NPI 1760798680
  NPD
• Tuba City Regional Health Care Corporation

  • Family Medicine Physician
  • Cameron, AZ
  • NPI 1134382211
  NPD
• Kayenta Alternative Rural Hospital

  • General Acute Care Hospital
  • Tonalea, AZ
  • NPI 1740359108
  NPD (past)
• North Country Healthcare Inc

  • Multi-Specialty Clinic/Center
  • Flagstaff, AZ
  • NPI 1053587261
  NPD (past)
• Tuba City Regional Health Care Corporation

  • General Acute Care Hospital
  • Tuba City, AZ
  • NPI 1780867556

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1366415846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3630",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860033630",
            "telephone_number": "928-522-9400",
            "fax_number": "928-774-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-522-9400",
            "fax_number": "928-774-4808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "167 North Main Street",
            "address_2": "TCRHCC",
            "address_purpose": "LOCATION",
            "city": "tuba city",
            "state": "AZ",
            "postal_code": "860450600",
            "country_code": "US",
            "telephone_number": "928-283-2501",
            "fax_number": "928-283-2761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "MIRAN",
        "middle_name": "JOELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-07",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "161302",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "49275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060012",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brianna Snow, LAC
• Reuben Snow, PMHNP - BC
• Patricia Vivian Snydar, PT, DPT
• Sarah Mariam Sohail, MD
• Leslie Solache
• Sharine Sonny, R.N.
• Sonora Quest Laboratories LLC
• Diane Sorden
• Amy Sorensen, M.S.
• Brigham Sorenson, DMD

• Pediatrics Physician in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.