NPIMap

Individual provider Active NPI

Cory Jay Miller

  • Ophthalmology Physician
  • Faribault, MN
National Provider Identifier
1114451259
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
69264 Issued in MN
Practice address
1575 20TH St NW Ste 101
Faribault, MN 55021-2931
Phone
(507) 332-9900
Fax
(507) 209-6220
NPI assigned
Apr 15, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Ophthalmology Physician 207W00000X 69264 MN Primary

Addresses

Primary practice location

1575 20TH St NW Ste 101
Faribault, MN 55021-2931

Mailing address

1575 20TH St NW Ste 101
Faribault, MN 55021-2931
Phone (507) 209-6214

Other practice location 1

1836 South Ave
LA Crosse, WI 54601-5429
Phone (608) 782-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210714001270 MN Practitioner - Ophthalmology 3870864341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Clinic of Faribault, PAGroup PAC ID 9436052677, 10 clinicians

Practice addresses (Care Compare)

1575 20TH St NW
Suite 101
Faribault, MN 55021-2931
Phone (507) 332-9900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.03 of 100Reported as group
Quality
100
Improvement activities
40
Cost
70.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery325
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Crossroads Surgery Center Inc Current Accepting new patients
Eye Clinic of Faribault PA CurrentSince Jul 19, 2021 Accepting new patients

Locations

1575 20th St NW
Ste 203
Faribault, MN 55021
Phone (612) 735-1469

1575 20th St NW
Ste 101
Faribault, MN 55021
Phone (507) 332-6800

101 Main St S
Ste 105
Le Sueur, MN 56058

Interoperability endpoints

  • Direct secure messaging: cmiller232408@direct.saint-lukes.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622160000000",
    "number": "1114451259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 20TH ST NW STE 101",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550212931",
            "telephone_number": "507-209-6214",
            "fax_number": "507-209-6220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 20TH ST NW STE 101",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550212931",
            "telephone_number": "507-332-9900",
            "fax_number": "507-209-6220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1836 South Ave",
            "address_purpose": "LOCATION",
            "city": "LA Crosse",
            "state": "WI",
            "postal_code": "546015429",
            "country_code": "US",
            "telephone_number": "608-782-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CORY",
        "middle_name": "JAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-15",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "69264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

Verify at the official NPI Registry.