Miranda K Detore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60610394 Issued in WA

Practice address

217 W Cataldo Ave
Spokane, WA 99201-2217

Phone

(509) 747-6194

Fax

(509) 252-2837

NPI assigned

Mar 16, 2015

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 WA

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

Uptown Providers PCGroup PAC ID 4284891243, 43 clinicians

Adams County Public Hospital District 2Group PAC ID 8022906122, shared by 2 NPIs, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lincoln Hospital Hospital, Davenport, WA, CCN 501305
• East Adams Rural Hospital Hospital, Ritzville, WA, CCN 501311

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Uptown Providers PC

  • Urgent Care Clinic/Center
  • Vancouver, WA
  • NPI 1255102034
  Medicare reassignment Care Compare group NPD
• Okanogan County Public Hospital Dist No 4

  • Medical Specialty Clinic/Center
  • Tonasket, WA
  • NPI 1750443834
  Medicare reassignment NPD
• Grant County Public Hospital District 3

  • Emergency Medical Services (Emergency Medicine) Physician
  • Ephrata, WA
  • NPI 1134283930
  Medicare reassignment
• Northwest Physician Associates PC

  • Physician Assistant
  • Arlington, WA
  • NPI 1275567919
  Medicare reassignment
• Okanogan County Public Hospital Dist No 4

  • Rural Health Clinic/Center
  • Tonasket, WA
  • NPI 1811555931
  NPD
• Uptown Providers PC

  • Urgent Care Clinic/Center
  • Vancouver, WA
  • NPI 1912702465
  NPD
• Okanogan County Public Hospital Dist No 4

  • Critical Access Hospital
  • Tonasket, WA
  • NPI 1164580700
  NPD (past)

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

• Lincoln County Hospital District #3

  • Critical Access Hospital
  • Davenport, WA
  • NPI 1841234598
  Care Compare affiliation

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1720471774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2242",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992102242",
            "telephone_number": "509-747-6194",
            "fax_number": "509-252-2837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 W CATALDO AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992012217",
            "telephone_number": "509-747-6194",
            "fax_number": "509-252-2837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETORE",
        "first_name": "MIRANDA",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-16",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60610394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert R Desroches, DDS
• Ryan C Desroches, DC
• Kaila Destefano
• Michael W Detar, MD
• Levi Deters, MD
• Brad Dettmann, RPH
• Yvonne J Deturenne, ARNP
• Isabel Detweiler
• Kimberlee Shannon Deuser, BSW
• Bar Devald, DO

• Physician Assistant in Spokane, WA
• Providers in Spokane, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.