NPIMap

Individual provider Active NPI

Charles Henry Miranda, MD

  • Internal Medicine Physician
  • Lone Tree, CO
National Provider Identifier
1437112000
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
33478 Issued in CO
Practice address
10103 Ridge Gate Pkwy
Suite 114
Lone Tree, CO 80124
Phone
(303) 799-8890
Fax
(303) 799-8891
NPI assigned
Apr 6, 2006
Last updated
Feb 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 33478 CO Primary
Pediatrics Physician 208000000X 33478 CO

Addresses

Primary practice location

10103 Ridge Gate Pkwy
Suite 114
Lone Tree, CO 80124

Mailing address

10103 Ridge Gate Pkwy
Suite 114
Lone Tree, CO 80124
Phone (303) 799-8890

Other identifiers 1

IdentifierTypeStateIssuer
89530063MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100224000287 CO Practitioner - Internal MedicinePractitioner - Pediatric Medicine 1153213327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of California, San Francisco School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

10103 Ridgegate Pkwy
Suite 114
Lone Tree, CO 80124-5524

10459 Park Meadows Dr
Suite 101
Lone Tree, CO 80124-5309
Phone (303) 799-8890

22 S Adams St
Denver, CO 80209-2908
Phone (303) 321-2452

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
33478COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Denver Internal Medicine and Pediatrics, P.C. CurrentSince Oct 1, 2003 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Baylor St. Luke's Medical Group Internal Medicine Past Accepting new patients

Locations

10103 Ridgegate Pkwy
Ste 114
Lone Tree, CO 80124
Phone (303) 799-8890

10459 Park Meadows Dr
#Ss
Lone Tree, CO 80124
Phone (303) 799-8890

10459 Park Meadows Dr
Ste 101
Lone Tree, CO 80124
Phone (303) 799-8890

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JIHBCA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 33

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265587200000",
    "number": "1437112000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10103 RIDGE GATE PKWY",
            "address_2": "SUITE 114",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "80124",
            "telephone_number": "303-799-8890",
            "fax_number": "303-799-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10103 RIDGE GATE PKWY",
            "address_2": "SUITE 114",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "80124",
            "telephone_number": "303-799-8890",
            "fax_number": "303-799-8891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "CHARLES",
        "middle_name": "HENRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2010-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "33478",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "33478",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89530063",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lone Tree, CO

Sources for this page

Verify at the official NPI Registry.