Carolyn Kelley Miller, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

32875 Issued in IA

Practice address

855 Illini Dr Ste 203
Silvis, IL 61282-2904

Phone

(309) 281-4812

Fax

(309) 281-4859

NPI assigned

Aug 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA, IL2 enrollments

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 2

Specialty

Pathology

Education

University of Iowa, RJ & L Carver College of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Genesis Medical Center-Davenport Hospital, Davenport, IA, CCN 160033
• Genesis HLTH System Dba Genesis MDL Ctr-Illini Hospital, Silvis, IL, CCN 140275
• Mercyone Clinton Medical Center Hospital, Clinton, IA, CCN 160080

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carolyn.miller@direct.genesishealth.com

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.

• Genesis Health System

  dba Genesis Health Group

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1477654945

  IL

  Medicare reassignment Care Compare group NPD
• Genesis Health System

  dba Genesis Convenient Care Bettendorf

  • Clinic/Center
  • Bettendorf, IA
  • NPI 1497772008
  Medicare reassignment
• Genesis Health System

  dba Genesis Health Group, Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Davenport, IA
  • NPI 1295196798
  NPD
• Genesis Health System

  dba Genesis Medical Center Dewitt

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD

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

• Genesis Health System

  dba Genesis Medical Center - Silvis

  • General Acute Care Hospital
  • Silvis, IL
  • NPI 1427132604
  Care Compare affiliation
• Genesis Health System

  dba Genesis Medical Center Davenport

  • General Acute Care Hospital
  • Davenport, IA
  • NPI 1972542264
  Care Compare affiliation
• Mercy Medical Center-Clinton, Inc

  dba MercyOne Clinton Medical Center

  • General Acute Care Hospital
  • Clinton, IA
  • NPI 1427093962
  Care Compare affiliation

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1235130766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 ILLINI DR STE 203",
            "city": "SILVIS",
            "state": "IL",
            "postal_code": "612822904",
            "telephone_number": "309-281-4812",
            "fax_number": "309-281-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 ILLINI DR STE 203",
            "city": "SILVIS",
            "state": "IL",
            "postal_code": "612822904",
            "telephone_number": "309-281-4812",
            "fax_number": "309-281-4859"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1814 E Locust St",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "528032038",
            "country_code": "US",
            "telephone_number": "563-324-0471",
            "fax_number": "563-324-2948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CAROLYN",
        "middle_name": "KELLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IA",
            "license": "32875",
            "primary": true
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "IA",
            "license": "32875",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2202424",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carolyn.miller@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "855 Illini Dr Ste 203",
            "city": "Silvis",
            "state": "IL",
            "country_code": "US",
            "postal_code": "612822904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sarah Jane Manthey, MOTR/L
• Joseph McCaughey, DPT
• Christie Lea McMann, PHARMD
• Jeff R Merideth, RPH
• Raymond Daniel Metzger, PTA
• Crissy Mohr
• Ashley Ann Moreno
• Magdy Mostafa, M.D.
• Nadia Mushtaq, MD
• Julie Marie Myers

• Anatomic Pathology & Clinical Pathology Physician in Silvis, IL
• Providers in Silvis, IL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.