Individual provider Active NPI

Carolyn G. Miller, MD

  • Anesthesiology Physician
  • Edmonds, WA
National Provider Identifier
1104873645
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD00037179 Issued in WA
Practice address
21601 76TH Ave W
Edmonds, WA 98026-7507
Phone
(425) 640-4000
Fax
(206) 672-0211
NPI assigned
May 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD00037179 WA Primary

Addresses

Primary practice location

21601 76TH Ave W
Edmonds, WA 98026-7507

Mailing address

1954 Fort Union Blvd Ste 119
Salt Lake City, UT 84121-6994
Phone (866) 910-6157

Other identifiers 1

IdentifierTypeStateIssuer
8246456MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20070723000151 WA Practitioner - Anesthesiology 8224083720 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Washington School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Anesthesia PCGroup PAC ID 2961399290, 91 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-4101

Hospital & facility affiliations

  • Swedish Edmonds Hospital Hospital, Edmonds, WA, CCN 500026

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Anesthesia PC Anesthesiology CurrentSince May 1, 2007 Accepting new patients

Locations

11808 Northup Way
Ste W300
Bellevue, WA 98005
Phone (425) 284-1545

21601 76th Ave W
Edmonds, WA 98026
Phone (425) 640-4000

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

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.

Hospital & facility affiliations 2

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1104873645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1954 FORT UNION BLVD STE 119",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841216994",
            "telephone_number": "866-910-6157",
            "fax_number": "801-733-5623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21601 76TH AVE W",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267507",
            "telephone_number": "425-640-4000",
            "fax_number": "206-672-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CAROLYN",
        "middle_name": "G.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00037179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8246456",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmonds, WA

Sources for this page

Verify at the official NPI Registry.