Miranda Luann Williams, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1650 Cochrane Cir Unit Meddac
Fort Carson, CO 80913-4604

Phone

(720) 325-4781

NPI assigned

Jan 30, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Divine Health Group LLCGroup PAC ID 6002271947, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Divine Health Group LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • La Junta, CO
  • NPI 1164120796
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1427764869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2273 ST CLAIRE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809104519",
            "telephone_number": "720-325-4781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COCHRANE CIR UNIT MEDDAC",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134604",
            "telephone_number": "720-325-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MIRANDA",
        "middle_name": "LUANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-30",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nickolas Willer, PA-C
• Sarah Denise Williams Lewis, DA
• Allyson Marie Williams, RN
• Cassandra Lucille Williams, LCSW
• Debra Momilani Williams, M.D.
• Cornelia J Willis, MD, MPH
• Erika Dawn Wilson, PHARM D
• Peggy Mae Wilson
• Michelle Dawn Wine, PSYD
• James Hunter Winegarner, M.D.

• Physician Assistant in Fort Carson, CO
• Providers in Fort Carson, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.
• 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.