Individual provider Active NPI

Paul C. Mileris, M.D.

  • Emergency Medicine Physician
  • Council Bluffs, IA
National Provider Identifier
1083723134
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
25500 Issued in IA
Practice address
933 E Pierce St
Council Bluffs, IA 51503-4626
Phone
(712) 396-6111
Fax
(712) 396-7026
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 17434 NE
Emergency Medicine Physician 207P00000X 25500 IA Primary

Addresses

Primary practice location

933 E Pierce St
Council Bluffs, IA 51503-4626

Mailing address

PO Box 2797
Omaha, NE 68103-2797
Phone (402) 354-4230

Other identifiers 2

IdentifierTypeStateIssuer
1083723134MedicaidIA
0053090MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20091113000127 IA Practitioner - Emergency Medicine 2264570134 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25500IAMDEmergency Medicine Physician
17434NEMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jennie Edmundson Memorial Hospital Emergency Medicine CurrentSince Jul 1, 1989 Accepting new patients

Locations

933 E Pierce St
Council Bluffs, IA 51503
Phone (712) 328-6000

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386892800000",
    "number": "1083723134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2797",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681032797",
            "telephone_number": "402-354-4230",
            "fax_number": "402-354-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 E PIERCE ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034626",
            "telephone_number": "712-396-6111",
            "fax_number": "712-396-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILERIS",
        "first_name": "PAUL",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NE",
            "license": "17434",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IA",
            "license": "25500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083723134",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0053090",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.