Organization Active NPI

Michael S. Miller DO, Facos, CWS, PC

  • Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1316072242
Registry record updated Mar 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MICHAEL S. MILLER DO, FACOS, CWS, PC
Practice address
3850 Shore Dr Ste 315
Indianapolis, IN 46254-4693
Phone
(317) 429-0061
Fax
(317) 222-1953
NPI assigned
Feb 22, 2007
Last updated
Mar 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2023

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

Authorized official

Name
Michael Seth Miller, DONPI 1730122268
Title
Owner
Phone
(317) 429-0061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 02001905 IN
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

3850 Shore Dr Ste 315
Indianapolis, IN 46254-4693

Mailing address

3850 Shore Dr Ste 315
Indianapolis, IN 46254-4693
Phone (317) 491-0061

Other identifiers 1

IdentifierTypeStateIssuer
200044490AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080512000280 IN Part B Supplier - Clinic/Group Practice 6406935733 Receives reassigned benefits from 33 practitioners
Practice locations: Indianapolis, IN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2075377Michael S Miller, DO, Fiacos, CWS, PC3850 Shore Dr #315, Indianapolis, IN 46254Certificate of waiverSep 24, 2027

National Provider Directory

National Provider Directory

Locations

3850 Shore Dr
Indianapolis, IN 46254
Phone (317) 529-0061

3850 Shore Dr
Ste 315
Indianapolis, IN 46254
Phone (317) 429-0061

8355 Rockville Rd
#120
Indianapolis, IN 46234

8355 Rockville Rd
Ste 120
Indianapolis, IN 46234
Phone (317) 213-5134

141 N Main St
Linton, IN 47441
Phone (812) 847-2141

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677974400000",
    "number": "1316072242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 SHORE DR STE 315",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462544693",
            "telephone_number": "317-491-0061",
            "fax_number": "317-222-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 SHORE DR STE 315",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462544693",
            "telephone_number": "317-429-0061",
            "fax_number": "317-222-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL S. MILLER DO, FACOS, CWS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2023-03-05",
        "certification_date": "2023-03-05",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-429-0061",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "02001905",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200044490A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.