Physician Compare National (NPI:1154740454)

HEALTHCARE PROVIDER: RENEE MAY SAYSON MIRANDA M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1154740454
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143599001
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190503002492
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MIRANDA
	Individual professional last name
Provider First Name	RENEE
	Individual professional first name
Provider Middle Name	MAY
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MEDICAL EDUCATION ASSISTANCE CORPORATION
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3870491269
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	131
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	917 W WALNUT ST
	Group Practice or individual's line 1 address
City	JOHNSON CITY
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376046527
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4234396464
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490038
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SMYTH COUNTY COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490002
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RUSSELL COUNTY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y