Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1760770960 Individual Practitioner Female Practitioner

Miranda R Dethier , PA-C

Physician Assistant • Menomonee Falls, WI

Professional Overview & Biography Verified Profile Summary

Miranda Dethier, PA-C is a registered healthcare professional specializing in Physician Assistant in Menomonee Falls, WI. Practice services are available at W165N5595 CREEKWOOD XING under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, x-ray of chest, 2 views, x-ray of chest, 2 views, front and side. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

W165n5595 Creekwood Xing

Menomonee Falls, WI 530510685

Telephone 2622521050
Fax 2625254781
Associated Practice Facility / Clinic
🏢 Prohealth Medical Group Inc Facility NPI 1912290909

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Menomonee Falls, WI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 14.5 Yrs
State Avg: 14.1 Yrs
Regional Practice Density
42 Specialists

Practicing in Menomonee Falls, WI (3517 Statewide)

Telehealth Adoption Rate
16.7% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
66.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
165 101 $160.05 $64.28
99213 Established patient office or other outpatient visit, typically 15 minutes
64 51 $95.47 $41.70
71046 X-ray of chest, 2 views
12 12 $86.67 $9.05

Medical Specialties & State Licenses

CMS Verified: 2026-06-23
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License WI 2758-23

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1760770960 (WI)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Dr. Abigail Davis , DNP

Nurse Practitioner

NPI 1225559321

Doctor of Nursing Practice

Katie Prucha , APNP

Nurse Practitioner - Family

NPI 1376943803

Advanced Practice Nurse Prescriber

Emily Jeska , FNP-BC

Nurse Practitioner - Family

NPI 1861026494

Family Nurse Practitioner (Board Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
📍
Updated Practice Location June 23, 2026

Registered at W165N5595 CREEKWOOD XING, MENOMONEE FALLS, WI 530510685 (Tel: 2622521050)

📍
Updated Business Mailing Address June 23, 2026

Registered at 470 E RED PINE CIR, DOUSMAN, WI 531188828 (Tel: 6089218334)

NPI Profile Active May 03, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location May 03, 2017

Registered at 840 W RACINE ST, JEFFERSON, WI 535491053 (Tel: 9206746000)

📍
Updated Business Mailing Address May 03, 2017

Registered at PO BOX 249, FORT ATKINSON, WI 535380249 (Tel: 9205685411)

👤
Provider Name / Credentials Updated May 03, 2017

Recorded as MIRANDA DETHIER, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 03, 2017

Physician Assistant (License #2758-23 in WI)

NPI Profile Active January 29, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location January 29, 2016

Registered at 1155 N MAYFAIR RD, TOSA WALK-IN CLINIC, MILWAUKEE, WI 532263462 (Tel: 4149557299)

📍
Updated Business Mailing Address January 29, 2016

Registered at 1155 N MAYFAIR RD, TOSA WALK-IN CLINIC, MILWAUKEE, WI 532263462 (Tel: 4149557299)

👤
Provider Name / Credentials Updated January 29, 2016

Recorded as MIRANDA DETHIER, PA-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 29, 2016

Physician Assistant (License #2758-23 in WI)

🟢
Initial NPI Registration & Enumeration July 21, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1760770960
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 21, 2011
Last Update: June 23, 2026
Sole Proprietor: No

Mailing Address

470 E Red Pine Cir

Dousman, WI 531188828

Phone: 6089218334

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.