Individual provider Active NPI

Eric Vincent T Miranda, PT

  • Physical Therapist
  • Harvard, IL
National Provider Identifier
1730336322
Registry record updated Aug 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-008337 Issued in IL
Practice address
901 Grant St
Harvard, IL 60033-1821
Phone
(815) 943-5431
NPI assigned
Aug 26, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070-008337 IL Primary

Addresses

Primary practice location

901 Grant St
Harvard, IL 60033-1821

Mailing address

901 Grant St
Harvard, IL 60033-1821
Phone (815) 943-5431

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130403000270 IL Practitioner - Physical Therapist in Private Practice 8123263639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians

Practice addresses (Care Compare)

901 Grant St
Harvard, IL 60033-1821
Phone (815) 943-5431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-008337ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation CurrentSince Oct 16, 2012 Accepting new patients
Mercy Health System Corporation CurrentSince Oct 16, 2012 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

348 S Division St
Harvard, IL 60033
Phone (815) 943-1122

901 Grant St
Harvard, IL 60033
Phone (815) 943-5431

Interoperability endpoints

  • Direct secure messaging: emiranda1506@direct.mhemail.org

Organizations & group practices 2

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": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219708800000",
    "number": "1730336322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 GRANT ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600331821",
            "telephone_number": "815-943-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 GRANT ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600331821",
            "telephone_number": "815-943-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "ERIC VINCENT",
        "middle_name": "T",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-008337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.