NPIMap

Individual provider Active NPI

Michael S Miranda, M.D.

  • Family Medicine Physician
  • Booneville, AR
National Provider Identifier
1699738195
Registry record updated Dec 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E1873 Issued in AR
Practice address
128 Daniel Ave
Booneville, AR 72927
Phone
(479) 675-2455
Fax
(479) 675-4940
NPI assigned
Apr 7, 2006
Last updated
Dec 9, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X E1873 AR Primary

Addresses

Primary practice location

128 Daniel Ave
Booneville, AR 72927

Mailing address

128 Daniel Ave
Booneville, AR 72927
Phone (479) 675-2455

Other identifiers 1

IdentifierTypeStateIssuer
135455001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20050423000082 AR Practitioner - Family Practice 7911945506 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital BoonevilleGroup PAC ID 1951530385, 13 clinicians

Practice addresses (Care Compare)

128 Daniel Dr
Booneville, AR 72927-4055
Phone (479) 675-2455

351 E Priddy St
Mercy Family Med Magazine
Magazine, AR 72943-8503
Phone (479) 969-8640

880 W Main St
Booneville, AR 72927-3443
Phone (479) 675-2800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E1873ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Booneville Current Accepting new patients
Arkansas Emergency Staffing Solutions, Inc CurrentSince Jun 3, 2012 Accepting new patients
Mercy Hospital Booneville CurrentSince Jul 14, 2018 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Apr 2, 2019 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Jan 6, 2014 Accepting new patients
Ess Hospitalist LLC CurrentSince Jun 3, 2012 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Jan 6, 2014 Accepting new patients
Mercy Hospital Booneville CurrentSince Jul 14, 2018 Accepting new patients
Sparks Medical Foundation Family Medicine Past Accepting new patients
Booneville Community Hospital, Inc Past Accepting new patients
Booneville Family Clinic Family Medicine Past Accepting new patients

Locations

128 Daniel Dr
Booneville, AR 72927
Phone (479) 675-2455

880 W Main St
Booneville, AR 72927
Phone (479) 675-2800

1015 Unity Rd
Crossett, AR 71635
Phone (870) 364-0590

3501 We Knight Dr
Fort Smith, AR 72903
Phone (479) 709-6700

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

1341 W 6th St
Waldron, AR 72958
Phone (479) 637-2136

Interoperability endpoints

  • Direct secure messaging: mmiranda473775@directb.mercy.net
  • Direct secure messaging: mmiranda483435@directc.mercy.net

Organizations & group practices 11

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260316800000",
    "number": "1699738195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 DANIEL AVE",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "72927",
            "telephone_number": "479-675-2455",
            "fax_number": "479-675-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 DANIEL AVE",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "72927",
            "telephone_number": "479-675-2455",
            "fax_number": "479-675-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2009-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E1873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135455001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Booneville, AR

Sources for this page

Verify at the official NPI Registry.