Individual provider Active NPI

Ebony Denise Miller, NP

  • Adult Health Nurse Practitioner
  • Rochester, NY
National Provider Identifier
1275041741
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
308480 Issued in NM
Practice address
105 Canal Landing Blvd Ste 1
Rochester, NY 14626-5107
Phone
(585) 368-4050
NPI assigned
Jan 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F308480-1 NY
Adult Health Nurse Practitioner 363LA2200X 308480 NM Primary

Addresses

Primary practice location

105 Canal Landing Blvd Ste 1
Rochester, NY 14626-5107

Mailing address

553 Black Walnut Dr
Rochester, NY 14615-1419
Phone (585) 802-0942

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20191212001272 NY Practitioner - Nurse Practitioner 8224461884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.62 of 100Reported as apm
Quality
74.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
308480NYMDLicensed Practical Nurse
308480NMMDAdult Health Nurse Practitioner
F308480-1NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Unity Hospital of Rochester CurrentSince Dec 6, 2019 Accepting new patients
The Unity Hospital of Rochester CurrentSince Dec 6, 2019 Accepting new patients

Locations

995 Senator Keating Blvd
Rochester, NY 14618
Phone (585) 279-3600

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

105 Canal Landing Blvd
Ste 1
Rochester, NY 14626
Phone (585) 368-4050

1555 Long Pond Rd
Rochester, NY 14626
Phone (585) 429-2289

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1516147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1275041741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 BLACK WALNUT DR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146151419",
            "telephone_number": "585-802-0942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 CANAL LANDING BLVD STE 1",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146265107",
            "telephone_number": "585-368-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "EBONY",
        "middle_name": "DENISE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-17",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F308480-1",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NM",
            "license": "308480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.