Idelee Garcia Miranda, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD 60122504 Issued in WA

Practice address

1230 7TH Ave
Kaiser Permanente Longview Kelso Medical Office
Longview, WA 98632-3166

Phone

(360) 636-2400

NPI assigned

Jan 11, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  Family Medicine, WA

  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1306192455

  Family Medicine

  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Frontier SNF Operations, LLC

  • Skilled Nursing Facility
  • Longview, WA
  • NPI 1801500079
  NPD (past)

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

{
    "created_epoch": "1263168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1821328055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 KOSTER BLVD APT 2A",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088374319",
            "telephone_number": "848-260-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 7TH AVE",
            "address_2": "KAISER PERMANENTE LONGVIEW KELSO MEDICAL OFFICE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323166",
            "telephone_number": "360-636-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "IDELEE",
        "middle_name": "GARCIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-11",
        "last_updated": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD 60122504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Northwest Permanente PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1230 7th Ave",
            "city": "Longview",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986323166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alexis Rea Minium, LMP
• Megan Minthorn, RN
• Mason Minton, LMP
• Diane Michelle Miollis, LMP
• Philip James Miollis, DDS
• Angela Lynn Mitchell, SUDP, LICSWA
• Cecily Kaninawe Mitchell, LMP
• Hannah Mitchell, DO
• Michael Mitchell
• Misty Mitchell

• Family Medicine Physician in Longview, WA
• Providers in Longview, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; 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.