Bret Lee Jacobsen Miller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5445 Issued in AZ

Practice address

11034 N 23Rd Dr Ste 105B
Phoenix, AZ 85029-4743

Phone

(602) 639-0189

Fax

(844) 955-2502

NPI assigned

Jul 31, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14816/brand/1/csg/1/fhir/r4
• Direct secure messaging: bret.jacobsen.miller.1@29405.direct.athenahealth.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.

• Revive Health and Wellness LLC

  • Primary Care Clinic/Center
  • Casa Grande, AZ
  • NPI 1528742814
  NPD
• Joseph G Abdo MD PC

  • Surgery Physician
  • Globe, AZ
  • NPI 1437285103
  NPD (past)

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1265864359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3637 W ECHO LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850514753",
            "telephone_number": "602-317-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11034 N 23RD DR STE 105B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294743",
            "telephone_number": "602-639-0189",
            "fax_number": "844-955-2502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 E Florence Blvd",
            "address_2": "Ste 139",
            "address_purpose": "LOCATION",
            "city": "Casa Grande",
            "state": "AZ",
            "postal_code": "851225303",
            "country_code": "US",
            "telephone_number": "520-381-6300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSEN MILLER",
        "first_name": "BRET",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-31",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juliane Elizabeth Jacobs, LMSW
• Juliette Jacobs
• Kathleen Bourke Jacobs
• Kenny Jacobs
• Sophie Jacobs, PA-C
• Angela Marie Jacobsen, RPH
• Eric Edwin Jacobsen, DDS
• Jeffrey R Jacobsen, MD
• Jiori Jacobsen, FNP-C
• Khira R Jacobsen

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.