Miyasari Ranoewidjojo, PA C
NPI 1033324645ActiveIndividual· Physician Assistant· Hackensack, NJ
Physician Assistant (PA C) in Hackensack, New Jersey, trained at State University of New York Downstate Medical Center (class of 2002). Mostly services rather than prescriptions: Medicare paid $4,877 for 41 patients in 2024, with only 18 Part D claims.
Overview
| NPI | 1033324645 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA C |
| Sole proprietor | No |
| NPI issued | May 14, 2007 |
| Last updated in NPPES | Dec 13, 2007 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | 25MP00118300 | NJ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (NJ) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 41 |
|---|---|
| Services billed | 42 across 8 procedure codes |
| Paid by Medicare | $4,877 |
Part D prescriptions in 2024
| Prescriptions (claims) | 18 · 18 30-day fills |
|---|---|
| Patients | 12 |
| Total drug cost | $77.21 |
| Generic share | 83% of claims |
Education and affiliations
| Medical school | State University of New York Downstate Medical Center |
|---|---|
| Graduation year | 2002 |
| Medicare specialty | Physician Assistant |
Medical group
- Hackensack Meridian Health Medical Group - Primary Care PCOld Bridge, NJ · 358 clinicians
Hospital affiliation
- Hackensack University Medical CenterHackensack, NJ
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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