Individual provider Active NPI

Kevin Mirandou, FNP-CP

  • Family Nurse Practitioner
  • Providence, RI
National Provider Identifier
1942826466
Registry record updated Sep 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN02408 Issued in RI
Practice address
180 Corliss St Ste E
Providence, RI 02904-2602
Phone
(401) 793-2928
NPI assigned
Jun 20, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F06200729 RI
Family Nurse Practitioner 363LF0000X APRN02408 RI Primary

Addresses

Primary practice location

180 Corliss St Ste E
Providence, RI 02904-2602

Mailing address

454 Indian Corner Rd
Saunderstown, RI 02874-2114

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20201103000162 RI Practitioner - Nurse Practitioner 6800206889 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Miriam HospitalGroup PAC ID 6901796408, 178 clinicians

Practice addresses (Care Compare)

180 Corliss St
Suite E1
Providence, RI 02904-2602
Phone (401) 793-2928

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN02408RIMDFamily Nurse Practitioner
F06200729RIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Miriam Hospital CurrentSince Sep 1, 2020 Accepting new patients
The Miriam Hospital CurrentSince Sep 1, 2020 Accepting new patients
The Miriam Hospital Past Accepting new patients

Locations

180 Corliss St
Ste E
Providence, RI 02904
Phone (401) 793-2928

1125 N Main St
Providence, RI 02904
Phone (401) 793-2928

180 Corliss St
Ste E1
Providence, RI 02904
Phone (401) 793-2928

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

Organizations & group practices 3

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 5

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": "1592611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1942826466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "454 INDIAN CORNER RD",
            "city": "SAUNDERSTOWN",
            "state": "RI",
            "postal_code": "028742114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 CORLISS ST STE E",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042602",
            "telephone_number": "401-793-2928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDOU",
        "first_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "FNP-CP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-20",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "RI",
            "license": "F06200729",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "RI",
            "license": "APRN02408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.