Individual provider Active NPI

Chelsea Miller, PA-C

  • Physician Assistant
  • Meridian, ID
National Provider Identifier
1043659196
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1012 Issued in ID
Practice address
4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442
Phone
(208) 452-5999
NPI assigned
Jun 21, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1012 ID Primary

Addresses

Primary practice location

4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442

Mailing address

1118 NW 16TH St
Suite 100
Fruitland, ID 83619-2271
Phone (208) 452-5999

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130828000298 ID Practitioner - Physician Assistant 2668615345 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Pine Dermatology PLLCGroup PAC ID 8729366455, 10 clinicians

Practice addresses (Care Compare)

110 Rattlesnake Ave
Mountain Home, ID 83647-4219
Phone (208) 898-7467

4664 N Penngrove Way
Suite 100
Meridian, ID 83646-7442
Phone (208) 898-7467

Merit-based Incentive Payment System (MIPS)

Final score
81.94 of 100Reported as group
Quality
69.02
Promoting interoperability
100
Improvement activities
40
Cost
70.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-1012IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Regional Medical Center Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594080000000",
    "number": "1043659196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 NW 16TH ST",
            "address_2": "SUITE 100",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192271",
            "telephone_number": "208-452-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-452-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CHELSEA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.