Individual provider Active NPI

Richard Edwin Miller, L.P.C.

  • Mental Health Counselor
  • Fort Worth, TX
National Provider Identifier
1124128723
Registry record updated Jul 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
15174 Issued in TX
Practice address
800 8TH Ave Ste 628
Ft Worth, TX 76104
Phone
(817) 720-5600
Fax
(817) 720-5601
NPI assigned
Sep 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 15174 TX Primary

Addresses

Primary practice location

800 8TH Ave Ste 628
Ft Worth, TX 76104

Mailing address

800 8TH Ave Ste 628
Ft Worth, TX 76104-2617
Phone (817) 720-5600

Other identifiers 4

IdentifierTypeStateIssuer
3789LCOtherTXBLUE CROSS & BLUE SHEILD
027896201MedicaidTX
10008748OtherTXAMERIGROUP
242273000OtherTXMAGELLAN PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240131000113 TX Practitioner - Mental Health Counselor 9931552510 Practice locations: Fort Worth, TX

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

800 8TH Ave
Suite 628
Fort Worth, TX 76104-2617

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15174TXMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532304000000",
    "number": "1124128723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 628",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761042617",
            "telephone_number": "817-720-5600",
            "fax_number": "817-720-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 8TH AVE STE 628",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "817-720-5600",
            "fax_number": "817-720-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "RICHARD",
        "middle_name": "EDWIN",
        "credential": "L.P.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2018-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "15174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHEILD",
            "identifier": "3789LC",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027896201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10008748",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN PROVIDER NUMBER",
            "identifier": "242273000",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.