Individual provider Active NPI

Laura Miranda, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Woodside, NY
National Provider Identifier
1841609302
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
ME145288 Issued in FL
Practice address
4750 59TH St
Woodside, NY 11377-5570
Phone
(718) 666-0849
NPI assigned
Aug 10, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Critical Care Medicine (Internal Medicine) Physician 207RC0200X ME145288 FL Primary

Addresses

Primary practice location

4750 59TH St
Woodside, NY 11377-5570

Mailing address

4750 59TH St
Woodside, NY 11377-5570
Phone (718) 666-0849

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200529000072 FL Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 5496176463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians

Practice addresses (Care Compare)

8201 W Broward Blvd
Plantation, FL 33324-2701
Phone (561) 997-0821

Hospital & facility affiliations

  • Westside Regional Medical Center Hospital, Plantation, FL, CCN 100228

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME145288FLMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intensive Care Consortium Inc Critical Care Medicine CurrentSince Jul 15, 2020 Accepting new patients

Locations

5301 S Congress Ave
Lantana, FL 33462
Phone (561) 548-3549

2001 Kingsley Ave
Orange Park, FL 32073
Phone (904) 215-7015

8201 W Broward Blvd
Plantation, FL 33324
Phone (954) 476-3900

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1407628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1841609302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 59TH ST",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113775570",
            "telephone_number": "718-666-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4750 59TH ST",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113775570",
            "telephone_number": "718-666-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-10",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "FL",
            "license": "ME145288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodside, NY

Sources for this page

Verify at the official NPI Registry.