Active NPI
Johnathan Chance Miller, MD
- General Practice Physician
- Saint Louis, MO
National Provider Identifier
1235623372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 2020035594
- Practice address
- 7122 Nashville Ave
Saint Louis, MO 63117-2337 - Phone
- (314) 329-8109
- Fax
- (314) 350-0231
- NPI assigned
- Jun 21, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 2020035594 | MO | Primary |
Addresses
Primary practice location
7122 Nashville Ave
Saint Louis, MO 63117-2337
Mailing address
7122 Nashville Ave
Saint Louis, MO 63117-2337
Phone (314) 329-8109
Other identifiers 25
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101074 | Other | GA | GA LICENSE |
| 31996 | Other | WV | WV LICENSE |
| 334502 | Other | LA | LA LICENSE |
| E-15164 | Other | AR | AR LICENSE |
| MD-50615 | Other | IA | IA LICENSE |
| 25MA11832200 | Other | NJ | NJ LICENSE |
| 36156953 | Other | IL | IL LICENSE |
| 31324 | Other | MS | MS LICENSE |
| 319711 | Other | NY | NY LICENSE |
| MED-PHYS-LIC-116474 | Other | MT | MT LICENSE |
| 12314722-1205 | Other | UT | UT LICENSE |
| 2024-00059 | Other | NC | NC LICENSE |
| 4301508656 | Other | MI | MI LICENSE |
| 37701 | Other | OK | OK LICENSE |
| MD.45970 | Other | AL | AL LICENSE |
| 1013323 | Other | MA | MA LICENSE |
| 2020035594 | Other | MO | MO LICENSE |
| 75961 | Other | MN | MN LICENSE |
| MD474783 | Other | PA | PA LICENSE |
| 35.141126 | Other | OH | OH LICENSE |
| ME165293 | Other | FL | FL LICENSE |
| U7016 | Other | TX | TX LICENSE |
| 101277587 | Other | VA | VA LICENSE |
| 70912 | Other | AZ | AZ LICENSE |
| D91957 | Other | MD | MD LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020035594 | MO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722470400000",
"number": "1235623372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7122 NASHVILLE AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631172337",
"telephone_number": "314-329-8109",
"fax_number": "314-350-0231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7122 NASHVILLE AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631172337",
"telephone_number": "314-329-8109",
"fax_number": "314-350-0231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "JOHNATHAN",
"middle_name": "CHANCE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-06-21",
"last_updated": "2024-08-01",
"certification_date": "2024-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MO",
"license": "2020035594",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GA LICENSE",
"identifier": "101074",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV LICENSE",
"identifier": "31996",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA LICENSE",
"identifier": "334502",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AR LICENSE",
"identifier": "E-15164",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA LICENSE",
"identifier": "MD-50615",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ LICENSE",
"identifier": "25MA11832200",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL LICENSE",
"identifier": "36156953",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MS LICENSE",
"identifier": "31324",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY LICENSE",
"identifier": "319711",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MT LICENSE",
"identifier": "MED-PHYS-LIC-116474",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UT LICENSE",
"identifier": "12314722-1205",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC LICENSE",
"identifier": "2024-00059",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MI LICENSE",
"identifier": "4301508656",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OK LICENSE",
"identifier": "37701",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AL LICENSE",
"identifier": "MD.45970",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MA LICENSE",
"identifier": "1013323",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO LICENSE",
"identifier": "2020035594",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN LICENSE",
"identifier": "75961",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE",
"identifier": "MD474783",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OH LICENSE",
"identifier": "35.141126",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FL LICENSE",
"identifier": "ME165293",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TX LICENSE",
"identifier": "U7016",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA LICENSE",
"identifier": "101277587",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZ LICENSE",
"identifier": "70912",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MD LICENSE",
"identifier": "D91957",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.