Individual provider Active NPI

Richard A. Miller

  • Clinical Social Worker
  • Santa Rosa, CA
National Provider Identifier
1215089636
Registry record updated Oct 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9151 Issued in CA
Practice address
1360 N Dutton Ave
Ste C
Santa Rosa, CA 95401-4687
Phone
(707) 303-1532
Fax
(707) 571-1895
NPI assigned
Jan 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 9151 CA Primary

Addresses

Primary practice location

1360 N Dutton Ave
Ste C
Santa Rosa, CA 95401-4687

Mailing address

1360 N Dutton Ave
Ste C
Santa Rosa, CA 95401-4687
Phone (707) 303-1532

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
9151CAMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444176000000",
    "number": "1215089636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 N DUTTON AVE",
            "address_2": "STE C",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014687",
            "telephone_number": "707-303-1532",
            "fax_number": "707-571-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 N DUTTON AVE",
            "address_2": "STE C",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014687",
            "telephone_number": "707-303-1532",
            "fax_number": "707-571-1895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "RICHARD",
        "middle_name": "A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2015-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "9151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.