Individual provider Active NPI

Martha Garcia Miranda

  • Primary Care Nurse Practitioner
  • Miami Gardens, FL
National Provider Identifier
1629743059
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
APRN11013518 Issued in FL
Practice address
18300 NW 62ND Ave Ste 210
Miami Gardens, FL 33015-8207
Phone
(786) 677-9922
NPI assigned
Aug 9, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X APRN11013518 FL Primary

Addresses

Primary practice location

18300 NW 62ND Ave Ste 210
Miami Gardens, FL 33015-8207

Mailing address

18300 NW 62ND Ave Ste 210
Miami Gardens, FL 33015-8207
Phone (786) 677-9922

Other identifiers 1

IdentifierTypeStateIssuer
APRN11013518OtherFLFLORIDA ARNP LICENSE

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20220504001600 FL Practitioner - Nurse Practitioner 0648667048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Passqual IncGroup PAC ID 2264848290, 4 clinicians

Practice addresses (Care Compare)

18706 NW 67TH Ave
Miami Gardens, FL 33015-2408
Phone (786) 677-9922

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11013518FLMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Passqual, Inc. CurrentSince Feb 1, 2022 Accepting new patients

Locations

18706 NW 67th Ave
Miami Gardens, FL 33015
Phone (786) 563-0280

18300 NW 62nd Ave
Ste 210
Miami Gardens, FL 33015
Phone (305) 474-4960

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1629743059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18300 NW 62ND AVE STE 210",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330158207",
            "telephone_number": "786-677-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18300 NW 62ND AVE STE 210",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330158207",
            "telephone_number": "786-677-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA MIRANDA",
        "first_name": "MARTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "APRN11013518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA ARNP LICENSE",
            "identifier": "APRN11013518",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Gardens, FL

Sources for this page

Verify at the official NPI Registry.