NPIMap

Individual provider Active NPI

Jackie S Miller, DO

  • Family Medicine Physician
  • Albany, MO
National Provider Identifier
1053353045
Registry record updated Dec 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
104860 Issued in MO
Practice address
1607 E US Highway 136
Albany, MO 64402-8223
Phone
(660) 726-3311
NPI assigned
Jun 12, 2006
Last updated
Dec 7, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 104860 MO Primary

Addresses

Primary practice location

1607 E US Highway 136
Albany, MO 64402-8223

Mailing address

1607 E US Highway 136
Albany, MO 64402-8223
Phone (660) 726-3311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080929000749 MO Practitioner - Family Practice 6305924465 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

106 N St
Lathrop Med Clinic
Lathrop, MO 64465-9609
Phone (816) 740-3282

302 N Park St
Stanberry, MO 64489-1246
Phone (660) 783-2707

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
58.28 of 100Reported as group
Quality
38.51
Improvement activities
40
Cost
70.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
104860MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cameron Regional Medical Center Inc CurrentSince Dec 7, 2020 Accepting new patients
Cameron Regional Medical Center, Inc. CurrentSince Dec 7, 2020 Accepting new patients
Cameron Regional Medical Center Inc Past Accepting new patients
Tri-County Health Department Past Accepting new patients

Locations

1600 E Evergreen St
Cameron, MO 64429
Phone (816) 632-2101

200 E Vermont St
King City, MO 64463
Phone (660) 552-4054

106 North St
Lathrop, MO 64465
Phone (816) 740-3282

1007 S Polk St
Maysville, MO 64469
Phone (816) 445-2123

Organizations & group practices 5

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512604800000",
    "number": "1053353045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 E US HIGHWAY 136",
            "city": "ALBANY",
            "state": "MO",
            "postal_code": "644028223",
            "telephone_number": "660-726-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 E US HIGHWAY 136",
            "city": "ALBANY",
            "state": "MO",
            "postal_code": "644028223",
            "telephone_number": "660-726-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JACKIE",
        "middle_name": "S",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2017-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "104860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, MO

Sources for this page

Verify at the official NPI Registry.