Individual provider Active NPI

Bart J Miller, PA

  • Physician Assistant
  • Green Bay, WI
National Provider Identifier
1093979080
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2310 Issued in WI
Practice address
704 S Webster Ave
Ste 100
Green Bay, WI 54301-3528
Phone
(920) 433-3456
NPI assigned
Jul 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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 2310 WI Primary

Addresses

Primary practice location

704 S Webster Ave
Ste 100
Green Bay, WI 54301-3528

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other identifiers 1

IdentifierTypeStateIssuer
43021900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20080927000203 WI Practitioner - Physician Assistant 1456428770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

2020 S Webster Ave
Accounting
Green Bay, WI 54301-3505

725 S Webster Ave
Green Bay, WI 54301-3504
Phone (920) 433-3456

744 S Webster Ave
Green Bay, WI 54301-3505

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc CurrentSince Jan 2, 2015 Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

704 S Webster Ave
Ste 200
Green Bay, WI 54301
Phone (920) 433-3410

704 S Webster Ave
Ste 100
Green Bay, WI 54301
Phone (920) 433-3410

Interoperability endpoints

  • Direct secure messaging: bmiller916430@direct.emplifyhealth.org
  • Direct secure messaging: bmiller33073@direct.thedacare.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1216339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417651200000",
    "number": "1093979080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE",
            "address_2": "STE 100",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013528",
            "telephone_number": "920-433-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BART",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-18",
        "last_updated": "2014-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43021900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.