Individual provider Active NPI

Kyle Scott Miller, D.O.

  • Pediatric Critical Care Medicine Physician
  • Austin, TX
National Provider Identifier
1154603512
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
Q4638 Issued in TX
Practice address
4900 Mueller Blvd
Austin, TX 78723-3079
Phone
(512) 324-0000
NPI assigned
Sep 12, 2011
Last updated
Nov 25, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X Q4638 TX Primary

Addresses

Primary practice location

4900 Mueller Blvd
Austin, TX 78723-3079

Mailing address

4900 Mueller Blvd
Austin, TX 78723-3079

Other identifiers 2

IdentifierTypeStateIssuer
Q4638OtherTXTEXAS MEDICAL LICENSE
347847103MedicaidTX

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190621000240 TX Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 0143554329 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
Q4638TXMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dell Children's Medical Group CurrentSince Jun 15, 2019 Accepting new patients
Dell Children's Medical Group Pediatrics CurrentSince Jun 15, 2019 Accepting new patients

Locations

1301 Barbara Jordan Blvd
Ste 200
Austin, TX 78723
Phone (512) 628-1800

4900 Mueller Blvd
Austin, TX 78723
Phone (512) 324-0165

1000 Hesters Crossing Rd
Round Rock, TX 78681
Phone (512) 628-1800

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.

NPI Registry JSON

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1154603512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 MUELLER BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787233079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 MUELLER BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787233079",
            "telephone_number": "512-324-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KYLE",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-12",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "Q4638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL LICENSE",
            "identifier": "Q4638",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "347847103",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.