Individual provider Active NPI

Maria Antonio-Miranda, M.D.

  • Pulmonary Disease Physician
  • Orange Park, FL
National Provider Identifier
1972525327
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
ME74317 Issued in FL
Practice address
1665 Kingsley Ave Ste 107
Orange Park, FL 32073-4415
Phone
(904) 269-9200
Fax
(904) 269-7796
NPI assigned
Jul 24, 2006
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X ME74317 FL Primary

Addresses

Primary practice location

1665 Kingsley Ave Ste 107
Orange Park, FL 32073-4415

Mailing address

1665 Kingsley Ave Ste 107
Orange Park, FL 32073-4415
Phone (904) 269-9200

Other identifiers 1

IdentifierTypeStateIssuer
255678200MedicaidFL

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
I20100308000985 FL Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 4385540640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1665 Kingsley Ave
Suite 107
Orange Park, FL 32073-4415
Phone (904) 269-9200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME74317FLMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clay Pulmonary Services PA Pulmonary Disease CurrentSince Jul 8, 2015 Accepting new patients

Locations

1409 Kingsley Ave
Ste 3B
Orange Park, FL 32073
Phone (904) 269-9200

1665 Kingsley Ave
Ste 107
Orange Park, FL 32073
Phone (904) 269-6565

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HIFBDA
  • FHIR API: https://fhir4.healow.com/fhir/r4/HIFBDA/Endpoint/HIFBDA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1972525327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1665 KINGSLEY AVE STE 107",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734415",
            "telephone_number": "904-269-9200",
            "fax_number": "904-269-7796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 KINGSLEY AVE STE 107",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734415",
            "telephone_number": "904-269-9200",
            "fax_number": "904-269-7796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONIO-MIRANDA",
        "first_name": "MARIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": "ME74317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255678200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.