Malcolm Baker Miracle, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6261 Issued in KY

Practice address

7607 Dixie Hwy
Florence, KY 41042-2644

Phone

(859) 655-6100

NPI assigned

Dec 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588550400000",
    "number": "1124184056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MADISON AVE",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410113313",
            "telephone_number": "859-655-6100",
            "fax_number": "859-655-6148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7607 DIXIE HWY",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410422644",
            "telephone_number": "859-655-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRACLE",
        "first_name": "MALCOLM",
        "middle_name": "BAKER",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "6261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "62610",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "E973",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60062619",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa A Miller
• Michael J Miller, MD
• Miranda Jean Miller, NP
• Hunter James Mills, PT, DPT
• Diane Minnix
• Hunter Pitman Mitchell, DMD
• Rebekah Mitchell
• Deepak Mittal, MD
• Devin Mitts
• Rebekah Leigh Mobley, DMD

• General Practice Dentistry in Florence, KY
• Providers in Florence, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.