Individual provider Active NPI

Dennis R Miller, O.D.

  • Optometrist
  • Warsaw, IN
National Provider Identifier
1003819442
Registry record updated Feb 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001871A Issued in IN
Practice address
2251 Dubois Dr
Warsaw, IN 46580-3212
Phone
(574) 269-2777
Fax
(574) 371-4697
NPI assigned
May 31, 2005
Last updated
Feb 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18001871A IN Primary

Addresses

Primary practice location

2251 Dubois Dr
Warsaw, IN 46580-3212

Mailing address

2251 Dubois Dr
Warsaw, IN 46580-3212
Phone (574) 269-2777

Other identifiers 2

IdentifierTypeStateIssuer
100342560MedicaidIN
100324560BMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090522000307 IN Practitioner - Optometry 1052333630 Reassigns benefits to 1 organization
Receives reassigned benefits from 3 practitioners
Practice locations: Laporte, IN

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

604 I St
La Porte, IN 46350-5530
Phone (219) 326-8855

Merit-based Incentive Payment System (MIPS)

Final score
89.94 of 100Reported as group
Quality
91.45
Improvement activities
40
Cost
77.88

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18001871AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Grossnickle Eye Center, Inc. Current Accepting new patients
Grossnickle Eye Center, Inc. CurrentSince Oct 1, 1993 Accepting new patients
Grossnickle Eye Center, Inc. CurrentSince Oct 1, 1993 Accepting new patients

Locations

4330 Edison Lakes Pkwy
Ste A
Mishawaka, IN 46545
Phone (574) 269-2777

2251 Dubois Dr
Warsaw, IN 46580
Phone (574) 269-2777

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/mi-gecenter

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360022400000",
    "number": "1003819442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 DUBOIS DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803212",
            "telephone_number": "574-269-2777",
            "fax_number": "574-371-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 DUBOIS DR",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803212",
            "telephone_number": "574-269-2777",
            "fax_number": "574-371-4697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "DENNIS",
        "middle_name": "R",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2013-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001871A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100342560",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100324560B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warsaw, IN

Sources for this page

Verify at the official NPI Registry.