Individual provider Active NPI

John Garth Oliver Miller, M.D.

  • Specialist
  • Idaho Falls, ID
National Provider Identifier
1295759520
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
00A768680 Issued in CA
Practice address
2327 Coronado St FL 2
Idaho Falls, ID 83404-7407
Phone
(208) 528-1750
NPI assigned
Jul 27, 2006
Last updated
Jun 30, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 00A768680 CA Primary
Surgical Critical Care Physician 2086S0102X M-10954 ID

Addresses

Primary practice location

2327 Coronado St FL 2
Idaho Falls, ID 83404-7407

Mailing address

2327 Coronado St FL 2
Idaho Falls, ID 83404-7407
Phone (208) 528-1750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120119000378 ID Practitioner - Critical Care (Intensivists)Practitioner - Interventional Pain ManagementPractitioner - Vascular Surgery 4981628518 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Interventional Pain Management, Vascular Surgery
Education
University of Calgary, Faculty of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho Falls Community Hospital LLCGroup PAC ID 9032441597, 6 clinicians

Practice addresses (Care Compare)

2327 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 528-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00A768680CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Falls Community Hospital LLC CurrentSince Nov 4, 2019 Accepting new patients
John G.O. Miller, PHD, M.D., a Professional Corporation Specialist PastSince Jul 1, 2003 Accepting new patients

Locations

3270 E 17th St
Ammon, ID 83406
Phone (208) 534-6568

2327 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-1000

2327 Coronado St
Fl 2
Idaho Falls, ID 83404
Phone (208) 528-1750

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.

Hospital & facility affiliations 2

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1295759520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2327 CORONADO ST FL 2",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "208-528-1750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2327 CORONADO ST FL 2",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "208-528-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JOHN",
        "middle_name": "GARTH OLIVER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "00A768680",
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "ID",
            "license": "M-10954",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.