Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MRS. MIRANDA R DETHIER PA-C
NPI 1760770960
Physician Assistant in Menomonee Falls, WI

Q: What is Miranda Dethier's NPI number?

The NPI number for Miranda Dethier is 1760770960. It was assigned to this individual provider in the NPPES registry on July 21, 2011. The provider is also known as Miss Miranda Rae Gordy.

Q: What is Miranda Dethier's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Miranda Dethier was last updated on June 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 50 days 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.

Active since July 21, 2011PECOS Enrolled

W165N5595 CREEKWOOD XING, MENOMONEE FALLS, WI 53051(262) 252-1050(262) 525-4781 Get Directions Write a Review

NPPES record last updated: June 23, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Mrs. Miranda R Dethier Pa-c NPPES

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

MRS. MIRANDA R DETHIER PA-C (NPI 1760770960) is an individual physician assistant in Menomonee Falls, Wisconsin, licensed in Wisconsin (2758-23) and active in the NPI registry since July 2011. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1760770960

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameMRS. MIRANDA R DETHIERCredential: PA-C

Location AddressW165N5595 CREEKWOOD XINGMenomonee Falls, WI 53051-0685

Mailing Address470 E Red Pine CirDousman, WI 53118-8828 · (608) 921-8334

Phone(262) 252-1050

Fax(262) 525-4781

Sole ProprietorNo

Enumeration DateJuly 21, 2011

Last NPPES UpdateJune 23, 2026

NPPES CertifiedJune 23, 2026

✔ NPI 1760770960 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 WI · 2758-23

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.

W165N5595 CREEKWOOD XING, Menomonee Falls, WI 53051

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Other Names 1

Former Name (1)Miss Miranda Rae Gordy

Other Identifiers 1

Medicaid1760770960WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Miranda R Dethier Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 53051 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

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.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

6 suppliers19 claims53 services$6.65 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

1 supplier12 claims12 services$19.50 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers15 claims15 services$111.33 avg. paid by Medicare

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

1 supplier11 claims11 services$168.52 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 6

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

ABIGAIL JEAN HAAG DAVIS DNP

Nurse Practitioner