Active NPI
Edmund E Miller, MD
- Ophthalmology Physician
- Boone, NC
National Provider Identifier
1124028428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 22596
- Practice address
- 610 State Farm Rd
Suite a
Boone, NC 28607-4738 - Phone
- (828) 264-0042
- Fax
- (828) 264-8612
- NPI assigned
- Jul 28, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 22596 | NC | Primary |
Addresses
Primary practice location
610 State Farm Rd
Suite a
Boone, NC 28607-4738
Mailing address
610 State Farm Rd
Suite a
Boone, NC 28607-4738
Phone (828) 264-0042
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8958907 | Medicaid | NC | |
| 2074256 | Other | FIRST HEALTH | |
| 4172879 | Medicaid | TN | |
| 3058058 | Other | TN | BCBS TN |
| 12160 | Other | PARTNERS | |
| 53862 | Other | NC | MEDCOST |
| 58907 | Other | NC | BCBS NC |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22596 | NC | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1124028428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 STATE FARM RD",
"address_2": "SUITE A",
"city": "BOONE",
"state": "NC",
"postal_code": "286074738",
"telephone_number": "828-264-0042",
"fax_number": "828-264-8612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 STATE FARM RD",
"address_2": "SUITE A",
"city": "BOONE",
"state": "NC",
"postal_code": "286074738",
"telephone_number": "828-264-0042",
"fax_number": "828-264-8612"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "EDMUND",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-28",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NC",
"license": "22596",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8958907",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "2074256",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4172879",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TN",
"identifier": "3058058",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARTNERS",
"identifier": "12160",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "53862",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "58907",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boone, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.