Individual provider Active NPI

Rakiya Vonita Faulkner Miller, MD

  • Obstetrics & Gynecology Physician
  • Jacksonville Beach, FL
National Provider Identifier
1053870964
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
TRN28526 Issued in FL
Practice address
1577 Roberts Dr Ste 323
Jacksonville Beach, FL 32250-3266
Phone
(904) 241-9775
NPI assigned
Mar 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Student in an Organized Health Care Education/Training Program 390200000X TRN28526 FL
Obstetrics & Gynecology Physician 207V00000X TRN28526 FL Primary

Addresses

Primary practice location

1577 Roberts Dr Ste 323
Jacksonville Beach, FL 32250-3266

Mailing address

1577 Roberts Dr Ste 323
Jacksonville Beach, FL 32250-3266

Other practice location 1

653-1 W 8th St # L17
Jacksonville, FL 32209-6511
Phone (904) 383-1037

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231205001250 FL Practitioner - Obstetrics/Gynecology 0143551952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vitalmd Group Holding LLCGroup PAC ID 8921091786, 535 clinicians

Practice addresses (Care Compare)

3225 Aviation Ave
Suite 700
Miami, FL 33133-4741
Phone (305) 273-4641

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN28526FLMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vitalmd Group Holding LLC Obstetrics & Gynecology CurrentSince Sep 11, 2023 Accepting new patients

Locations

1577 Roberts Dr
Ste 323
Jax Bch, FL 32250
Phone (904) 241-9775

3225 Aviation Ave
Ste 700
Miami, FL 33133
Phone (305) 273-4641

Organizations & group practices 1

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": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1053870964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 ROBERTS DR STE 323",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1577 ROBERTS DR STE 323",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322503266",
            "telephone_number": "904-241-9775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "653-1 W 8th St # L17",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322096511",
            "country_code": "US",
            "telephone_number": "904-383-1037",
            "fax_number": "904-244-4059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "RAKIYA",
        "middle_name": "VONITA FAULKNER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN28526",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "TRN28526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

Verify at the official NPI Registry.