NPIMap

Individual provider Active NPI

Kevin Wayne Miller, FNP-C

  • Nurse Practitioner
  • Lubbock, TX
National Provider Identifier
1205494499
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP139593 Issued in TX
Practice address
5115 80TH St
Lubbock, TX 79424-3017
Phone
(806) 788-4368
NPI assigned
Jun 3, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP139593 TX Primary
Family Nurse Practitioner 363LF0000X AP139593 TX

Addresses

Primary practice location

5115 80TH St
Lubbock, TX 79424-3017

Mailing address

5115 80TH Street
Lubbock, TX 79424
Phone (806) 788-4368

Other practice location 1

3514 21st St
Lubbock, TX 79410-1210
Phone (806) 725-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20190711002806 TX Practitioner - Nurse Practitioner 1355676479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Texas Digestive Disease Center P.a.Group PAC ID 7416043161, 10 clinicians

Practice addresses (Care Compare)

5115 80TH St
Lubbock, TX 79424-3017
Phone (806) 788-4368

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.35 of 100Reported as group
Quality
74.14
Promoting interoperability
100
Improvement activities
40
Cost
67.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP139593TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
West Texas Digestive Disease Center, PA Nurse Practitioner CurrentSince Jul 1, 2019 Accepting new patients
South Plains Pathology Inc Past Accepting new patients

Locations

5115 80th St
Lubbock, TX 79424
Phone (806) 788-4368

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1205494499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 80TH STREET",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79424",
            "telephone_number": "806-788-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 80TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794243017",
            "telephone_number": "806-788-4368"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3514 21st St",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794101210",
            "country_code": "US",
            "telephone_number": "806-725-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KEVIN",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-03",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP139593",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP139593",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.