Kelly Miranda, PA-C, MPT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

52008 Issued in CA

Practice address

26520 Cactus Ave
Moreno Valley, CA 92555-3927

Phone

(951) 486-4698

NPI assigned

Aug 29, 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

Medicare fee-for-service enrollment

Enrolled in CA

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

De Anza Orthopedic Medical Group IncGroup PAC ID 9739481375, 18 clinicians

County of RiversideGroup PAC ID 6507754488, 190 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kmiranda149202@direct.llu.edu

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.

• County of Riverside

  • Federally Qualified Health Center (FQHC)
  • Indio, CA
  • NPI 1023122967
  Medicare reassignment Care Compare group
• De Anza Orthopedic Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Moreno Valley, CA
  • NPI 1255762340
  Medicare reassignment Care Compare group
• Kelly Miranda Physician Assistant Inc.

  • Orthopaedic Surgery Physician
  • Moreno Valley, CA
  • NPI 1245887645
  NPD Authorized official
• County of Riverside

  • Federally Qualified Health Center (FQHC)
  • Perris, CA
  • NPI 1194839035
  NPD
• County of Riverside

  • Clinical Medical Laboratory
  • Riverside, CA
  • NPI 1952496010
  NPD
• Cooper Physical Therapy, Inc

  • Physical Therapist
  • Hemet, CA
  • NPI 1205026044
  NPD (past)
• D&T Physical Therapy Partners Inc

  dba Cooper Physical Therapy

  • Physical Therapy Clinic/Center
  • Hemet, CA
  • NPI 1871915009

  Physical Therapist

  NPD (past)
• Gordon David Mason and Emily Sue Mason

  dba Mason Physical Therapy

  • Physical Therapist
  • Riverside, CA
  • NPI 1982630182
  NPD (past)
• Star Orthopaedics, Inc.

  • Orthopaedic Surgery Physician
  • La Quinta, CA
  • NPI 1831364975
  NPD (past)

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

• County of Riverside

  • General Acute Care Hospital
  • Moreno Valley, CA
  • NPI 1821159195
  Care Compare affiliation

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413417600000",
    "number": "1578671558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2358 SHADOW HILL DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063462",
            "telephone_number": "951-369-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553927",
            "telephone_number": "951-486-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "KELLY",
        "name_prefix": "Ms.",
        "credential": "PA-C, MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2014-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT23425",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karla Miranda-Sosa I
• Abigail Rainae Miranda
• Ana Miranda
• Cristina Miranda
• Jacqueline Miranda
• Saira Deyanira Miranda
• Tairy Miranda
• Audrey Lee Mitchell
• Eudora Mitchell
• Melissa Marie Mitchell, PHARM.D.

• Physician Assistant in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; 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.