NPIMap

Organization Active NPI

Peninsula Eyecare Medical Associates

Doing business as Peninsula Eyecare Medical Assoc

  • Ophthalmology Physician
  • San Pedro, CA
National Provider Identifier
1033131933
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
PENINSULA EYECARE MEDICAL ASSOCIATES
Doing business as
Peninsula Eyecare Medical Assoc
Practice address
800 S Pacific Ave Ste a
San Pedro, CA 90731-3267
Phone
(310) 547-9991
Fax
(310) 547-2389
NPI assigned
Jul 23, 2006
Last updated
Apr 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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

Authorized official

Name
Kenneth Joel Miller, MDNPI 1073537817
Title
President
Phone
(310) 547-9991

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

800 S Pacific Ave Ste a
San Pedro, CA 90731-3267

Mailing address

800 S Pacific Ave Ste a
San Pedro, CA 90731-3267
Phone (310) 547-9991

Other names 2

  • PENINSULA EYECARE MEDICAL ASSOC Doing business as
  • Kenneth J Miller MD INC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050718000991 CA Part B Supplier - Clinic/Group Practice 9234166695 Receives reassigned benefits from 6 practitioners
Practice locations: San Pedro, CA

National Provider Directory

National Provider Directory

Locations

1360 W 6th St
Ste 215
San Pedro, CA 90732
Phone (310) 547-9991

800 S Pacific Ave
Ste A
San Pedro, CA 90731
Phone (310) 547-9991

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1033131933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S PACIFIC AVE STE A",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313267",
            "telephone_number": "310-547-9991",
            "fax_number": "310-547-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S PACIFIC AVE STE A",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313267",
            "telephone_number": "310-547-9991",
            "fax_number": "310-547-2389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA EYECARE MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JOEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-547-9991",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PENINSULA EYECARE MEDICAL ASSOC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PENINSULA EYECARE MEDICAL ASSOC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kenneth J Miller MD INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.