NPIMap

Individual provider Active NPI

Brock W. Millet, M.D.

  • Family Medicine Physician
  • Coquille, OR
National Provider Identifier
1265758973
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD162167 Issued in OR
Practice address
209 N Central Blvd
Coquille, OR 97423-1274
Phone
(541) 396-7295
Fax
(541) 396-7295
NPI assigned
Apr 20, 2010
Last updated
Jan 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD162167 OR Primary

Addresses

Primary practice location

209 N Central Blvd
Coquille, OR 97423-1274

Mailing address

209 N Central Blvd
Coquille, OR 97423-1274
Phone (541) 396-7295

Other identifiers 1

IdentifierTypeStateIssuer
500656979MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20130730000586 OR Practitioner - Family Practice 5193984151 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Eastern Virginia Medical School, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Bend Medical Center IncGroup PAC ID 5597677716, 92 clinicians

Practice addresses (Care Compare)

790 E 5TH St
Coquille, OR 97423-1755
Phone (541) 396-3111

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD162167ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Bend Medical Center Inc CurrentSince Sep 2, 2013 Accepting new patients
Coquille Valley Hospital District CurrentSince Sep 1, 2013 Accepting new patients
North Bend Medical Center Inc CurrentSince Sep 2, 2013 Accepting new patients
Daiya Healthcare PLLC CurrentSince Nov 1, 2022 Accepting new patients
Coquille Valley Hospital District CurrentSince Sep 1, 2013 Accepting new patients

Locations

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

209 N Central Blvd
Coquille, OR 97423
Phone (541) 329-0144

790 E 5th St
Coquille, OR 97423
Phone (541) 396-3101

940 E 5th St
Coquille, OR 97423
Phone (541) 396-3101

10435 SE Cora St
Portland, OR 97266
Phone (503) 760-1737

75 Shore Dr
Saint Helens, OR 97051
Phone (503) 397-2713

Interoperability endpoints

  • Direct secure messaging: bmillet124788@secure.stcharleshealthcare.org
  • FHIR API: https://fhir-myrecord.cerner.com/r4/5c5c3b5c-6128-40bc-b71b-102ccb82d7e7/

Organizations & group practices 5

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 6

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": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767571200000",
    "number": "1265758973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 N CENTRAL BLVD",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231274",
            "telephone_number": "541-396-7295",
            "fax_number": "541-396-7295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 N CENTRAL BLVD",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231274",
            "telephone_number": "541-396-7295",
            "fax_number": "541-396-7295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLET",
        "first_name": "BROCK",
        "middle_name": "W.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-20",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD162167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500656979",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coquille, OR

Sources for this page

Verify at the official NPI Registry.