Miranda Tadevich

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95029206 Issued in CA

Practice address

445 W Eaton Ave
Tracy, CA 95376-3420

Phone

(209) 830-4075

NPI assigned

Jul 22, 2022

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 names 1

• Miranda Downs Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CO, CA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/4045/brand/3/csg/61/fhir/r4
• Direct secure messaging: mtadevich684970@hisp.ehr.sutterhealth.org
• FHIR API: https://api.platform.athenahealth.com/1922/brand/1/csg/1/fhir/r4

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.

• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment NPD
• Advanced Urgent Care LLC

  • Urgent Care Clinic/Center
  • Brighton, CO
  • NPI 1841579703
  Medicare reassignment NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Platte River Medical Clinic LLC

  • Family Medicine Physician
  • Brighton, CO
  • NPI 1477667244
  NPD

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

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1669107512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228",
            "telephone_number": "209-830-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 W EATON AVE",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763420",
            "telephone_number": "209-830-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADEVICH",
        "first_name": "MIRANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-22",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "APN.0997765",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95029206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "advanced@advurgent.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2801 Purcell St",
            "city": "Brighton",
            "state": "CO",
            "country_code": "US",
            "postal_code": "806013551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "DOWNS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Franchasca Taipaleti
• Johnny Castro Taitingfong Jr
• Takahashi Sports Chiropractic, Inc
• Norie Takahashi, D.C.
• Spencer Takechi

• Family Nurse Practitioner in Tracy, CA
• Providers in Tracy, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.