Miranda M Macko, AGNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704367492 Issued in MI

Practice address

904 Mason St
Dearborn, MI 48124-2215

Phone

(313) 586-7525

NPI assigned

Apr 8, 2024

Last updated

Dec 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ma Sobh DO PLCGroup PAC ID 4385876689, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020
• Beaumont Hospital - Taylor Hospital, Taylor, MI, CCN 230270
• Corewell Health Wayne Hospital Hospital, Wayne, MI, CCN 230142
• Corewell Health Trenton Hospital Hospital, Trenton, MI, CCN 230176

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Ma Sobh DO PLC

  • Cardiovascular Disease Physician
  • Dearborn, MI
  • NPI 1568889376
  Medicare reassignment Care Compare group NPD
• Fahs Surgical Services PLLC

  • Surgery Physician
  • Dearborn, MI
  • NPI 1225453475
  NPD (past)

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

• Oakwood Healthcare Inc

  dba Beaumont Outpatient Diabetes Education

  • Community Health Clinic/Center
  • Dearborn, MI
  • NPI 1790414670

  Hospital

  Care Compare affiliation
• Oakwood Healthcare, Inc.

  dba Beaumont Hospital - Wayne

  • General Acute Care Hospital
  • Wayne, MI
  • NPI 1295785285
  Care Compare affiliation
• Oakwood Healthcare, Inc.

  dba Beaumont Hospital - Taylor

  • General Acute Care Hospital
  • Taylor, MI
  • NPI 1487605168
  Care Compare affiliation
• Oakwood Healthcare, Inc.

  dba Beaumont Hospital - Dearborn

  • General Acute Care Hospital
  • Dearborn, MI
  • NPI 1740230119
  Care Compare affiliation
• Oakwood Healthcare, Inc.

  dba Beaumont Hospital - Trenton

  • General Acute Care Hospital
  • Trenton, MI
  • NPI 1740230648
  Care Compare affiliation

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734220800000",
    "number": "1710730981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 MASON ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242215",
            "telephone_number": "313-586-7525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 MASON ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242215",
            "telephone_number": "313-586-7525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKO",
        "first_name": "MIRANDA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-12-15",
        "certification_date": "2024-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704367492",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704367492",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MI",
            "license": "4704367492",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704367492",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Steven Macdonald, D.D.S.
• Rima Machhour
• Michele L Mack, CRNA
• Fatmeh Mackie
• Tamara Mackie, DDS
• Macomb Physical Therapy & Rehab LLC
• Haris C. Macris, M.D.
• Rashad Ghassan Madarani I
• Briana Maddux
• Ayeda Madhigi

• Nurse Practitioner in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.
• 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.