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MIRAKLE AVERY
NPI 1013772391
Physician Assistant in Columbia, SC

Active since February 16, 2024PECOS EnrolledAccepts Medicare Assignment
2611 FOREST DR STE 200, COLUMBIA, SC 29204(803) 799-3263 Get Directions Write a Review

NPPES record last updated: January 15, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mirakle Avery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIRAKLE AVERY (NPI 1013772391) is an individual physician assistant in Columbia, South Carolina, licensed in South Carolina (6095) and active in the NPI registry since February 2024. She is enrolled in Medicare PECOS and is a graduate of Medical University Of South Carolina College Of Medicine (2025).

NPPES Registry Identity

NPI1013772391
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMIRAKLE AVERY
Location Address2611 FOREST DR STE 200Columbia, SC 29204-2371
Mailing Address2611 Forest Dr Ste 200Columbia, SC 29204-2371 · (804) 799-3263
Phone(803) 799-3263
Sole ProprietorNo
Medical School CMSMedical University Of South Carolina College Of MedicineGraduated 2025
Enumeration DateFebruary 16, 2024
Last NPPES UpdateJanuary 15, 2026
NPPES CertifiedJanuary 15, 2026
✔ NPI 1013772391 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in SC · 6095
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
2611 FOREST DR STE 200, Columbia, SC 29204
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mirakle Avery is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID446734966
PECOS Enrollment IDI20260324000740
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29204 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$83.18 typical visit price
range $53.57 – $163.84
Typical copayment $20.79 (range $13.39 – $40.96)
Most-billed visit code 99203
Established Patient
$67.12 typical visit price
range $16.96 – $133.52
Typical copayment $16.78 (range $4.24 – $33.38)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARK A DAVIS PA-C
Physician Assistant
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263
AYESHA MONAY MCCORMICK AGNP-C
Nurse Practitioner (Gerontology)
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263
MARIANA CARMEN JEONG PA-C
Physician Assistant
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263
ALAN REJONIS MD
Pain Medicine (Interventional Pain Medicine)
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263
TROY H BLANKS PA
Physician Assistant
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263
ALEXANDRA ANDERSON
Physician Assistant
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263
DR. NEERAJ SRIRAM MD
Anesthesiology (Pain Medicine)
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263
PALMETTO PAIN MANAGEMENT, LLC
Non-Pharmacy Dispensing Site
2611 FOREST DR STE 200
COLUMBIA, SC 29204
Richland County (803) 779-3263

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mirakle Avery's NPI number?

The NPI number for Mirakle Avery is 1013772391. It was assigned to this individual provider in the NPPES registry on February 16, 2024.

Where is Mirakle Avery located?

Mirakle Avery practices at 2611 Forest Dr Ste 200, Columbia, SC 29204. The listed phone number is (803) 799-3263.

What is Mirakle Avery's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Mirakle Avery enrolled in Medicare?

Yes. Mirakle Avery is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Mirakle Avery was last updated on January 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.