Individual provider Active NPI

Matthew Shayne Miller, CRNA

  • Certified Registered Nurse Anesthetist
  • Columbus, OH
National Provider Identifier
1063465706
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRNCRNA13371 Issued in OH
Practice address
410 W 10TH Ave
Columbus, OH 43210-1240
Phone
(614) 293-8487
NPI assigned
May 17, 2006
Last updated
Apr 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1268 SC
Certified Registered Nurse Anesthetist 367500000X APRNCRNA13371 OH Primary

Addresses

Primary practice location

410 W 10TH Ave
Columbus, OH 43210-1240

Mailing address

700 Ackerman Rd Ste 2120
Columbus, OH 43202-1559
Phone (614) 293-8487

Other practice location 1

1320 W Main St
Newark, OH 43055-1822
Phone (220) 564-4217

Other practice location 2

1320 W Main St
Newark, OH 43055-1822
Phone (220) 564-4217

Other identifiers 2

IdentifierTypeStateIssuer
0067440MedicaidOH
AN0895MedicaidSC

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mmiller14474@lickingmemorial.medicity.net Other LICKING MEMORIAL PROFESSIONAL CORPORATION
Direct Messaging Address mmiller14474@lickingmemorial.medicity.net Other LICKING MEMORIAL PROFESSIONAL CORPORATION

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120726000317 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224032529 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
University of South Carolina School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osu Observation Medicine, LLCGroup PAC ID 3375692270, 423 clinicians
Western Ohio Sedation Associates LLCGroup PAC ID 3779848684, 12 clinicians

Practice addresses (Care Compare)

410 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 293-8487

75 Sylvania Dr
Beavercreek, OH 45440-3237
Phone (937) 320-5050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
1268SCMDClinical Psychologist
APRNCRNA13371OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 6, 2024 Accepting new patients
New Albany Orthopedic Anesthesia LLC CurrentSince Feb 27, 2025 Accepting new patients
Osu Observation Medicine, LLC CurrentSince Apr 1, 2024 Accepting new patients
Radius Anesthesia of Ohio, LLC CurrentSince Mar 1, 2024 Accepting new patients
Western Ohio Sedation Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 16, 2024 Accepting new patients
Coshocton Anesthesia Professionals LTD Nurse Anesthetist, Certified Registered CurrentSince Jun 5, 2020 Accepting new patients
Columbus Anesthesia Services LLC CurrentSince Nov 1, 2025 Accepting new patients
Licking Memorial Professional Corporation Past Accepting new patients
Anesthesiology Consultants of Columbia, PA Past Accepting new patients
Orange ASC, LTD Past Accepting new patients
Hendrick Anesthesia Network Past Accepting new patients

Locations

111 Town Square Pl
Ste 420
Jersey City, NJ 07310
Phone (201) 258-4700

100 E Campus View Blvd
Ste 250
Columbus, OH 43235
Phone (267) 817-8902

175 S 3rd St
Ste 200
Columbus, OH 43215
Phone (267) 817-8902

3600 Stelzer Rd
Ste 100
Columbus, OH 43219
Phone (614) 255-2900

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

410 W 10th Ave
#N429
Columbus, OH 43210
Phone (614) 293-4705

700 Ackerman Rd
Ste 2120
Columbus, OH 43202

700 Ackerman Rd
Ste 570
Columbus, OH 43202
Phone (614) 293-2046

1460 Orange St
Coshocton, OH 43812
Phone (740) 545-7919

4200 Indian Ripple Rd
Dayton, OH 45440
Phone (937) 320-5050

75 Sylvania Dr
Dayton, OH 45440
Phone (937) 320-5050

425 W 5th St
East Liverpool, OH 43920
Phone (330) 385-7200

9000 N Main St
Ste 405
Englewood, OH 45415
Phone (937) 320-5050

Organizations & group practices 11

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 4

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1063465706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 2120",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021559",
            "telephone_number": "614-293-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 W 10TH AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101240",
            "telephone_number": "614-293-8487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 W Main St",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "OH",
            "postal_code": "430551822",
            "country_code": "US",
            "telephone_number": "220-564-4217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1320 W Main St",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "OH",
            "postal_code": "430551822",
            "country_code": "US",
            "telephone_number": "220-564-4217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MATTHEW",
        "middle_name": "SHAYNE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "1268",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "APRNCRNA13371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0067440",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AN0895",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmiller14474@lickingmemorial.medicity.net",
            "affiliation": "Y",
            "endpointDescription": "DIRECT EMAIL ADDRESS",
            "affiliationName": "LICKING MEMORIAL PROFESSIONAL CORPORATION",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "OTHER",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "1320 W Main St",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430551822",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmiller14474@lickingmemorial.medicity.net",
            "affiliation": "Y",
            "endpointDescription": "DIRECT EMAIL ADDRESS",
            "affiliationName": "LICKING MEMORIAL PROFESSIONAL CORPORATION",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "OTHER",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "OTHER",
            "address_1": "1320 W Main St",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430551822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.