NPIMap

Individual provider Active NPI

Ronald Miller, M.D.

  • Pediatrics Physician
  • Twin Falls, ID
National Provider Identifier
1104860246
Registry record updated Jul 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
M5473 Issued in ID
Practice address
630 Addison Ave W
Suite 100
Twin Falls, ID 83301-5491
Phone
(208) 733-4343
Fax
(208) 734-9941
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X M5473 ID Primary

Addresses

Primary practice location

630 Addison Ave W
Suite 100
Twin Falls, ID 83301-5491

Mailing address

630 Addison Ave W
Suite 100
Twin Falls, ID 83301-5491
Phone (208) 733-4343

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M5473IDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Magic Valley Regional Medical Center LTD Past Accepting new patients
St Luke'S Clinic LLC Pediatrics PastSince Apr 28, 2015 Accepting new patients

Organizations & group practices 2

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184457600000",
    "number": "1104860246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 ADDISON AVE W",
            "address_2": "SUITE 100",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015491",
            "telephone_number": "208-733-4343",
            "fax_number": "208-734-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 ADDISON AVE W",
            "address_2": "SUITE 100",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015491",
            "telephone_number": "208-733-4343",
            "fax_number": "208-734-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "RONALD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2007-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M5473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.