Individual provider Active NPI

Jeff Miller

  • Family Nurse Practitioner
  • Hattiesburg, MS
National Provider Identifier
1215310388
Registry record updated Jul 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R877642 Issued in MS
Practice address
6333 U S Highway 49 Ste 10
Hattiesburg, MS 39401-3133
Phone
(601) 261-5688
NPI assigned
Jul 7, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R877642 MS Primary

Addresses

Primary practice location

6333 U S Highway 49 Ste 10
Hattiesburg, MS 39401-3133

Mailing address

15 Kendallbrook Xing
Hattiesburg, MS 39402-5520

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151002001886 MS Practitioner - Nurse Practitioner 6103134622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Central Clinics, IncGroup PAC ID 4385876655, 117 clinicians

Practice addresses (Care Compare)

1203 Ave B
Ellisville, MS 39437-2080
Phone (601) 477-2226

1410 Jefferson St
Laurel, MS 39440-4243
Phone (601) 425-7522

1420 Jefferson St
Laurel, MS 39440-4243
Phone (601) 649-6823

1430 Jefferson St
Laurel, MS 39440-4243
Phone (601) 425-2273

1440 Jefferson St
Laurel, MS 39440-4243
Phone (601) 649-6213

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Clinics, Inc CurrentSince Mar 26, 2018 Accepting new patients
South Central Clinics, Inc Current Accepting new patients
South Central Clinics, Inc CurrentSince Mar 26, 2018 Accepting new patients
South Central Clinics, Inc. Past Accepting new patients

Locations

1203 B Ave
Ellisville, MS 39437
Phone (601) 477-8553

1515 Jefferson St
Laurel, MS 39440
Phone (601) 425-4893

Interoperability endpoints

  • Direct secure messaging: jeff.miller@direct.scrmc.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436227200000",
    "number": "1215310388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 KENDALLBROOK XING",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394025520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 U S HIGHWAY 49 STE 10",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394013133",
            "telephone_number": "601-261-5688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JEFF",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R877642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.