Individual provider Active NPI

Jaclyn Christine Miller

  • Certified Registered Nurse Anesthetist
  • Raleigh, NC
National Provider Identifier
1316328115
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
007392 Issued in NC
Practice address
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone
(919) 784-3100
NPI assigned
Jun 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN575481 PA
Certified Registered Nurse Anesthetist 367500000X 007392 NC Primary

Addresses

Primary practice location

4420 Lake Boone TRL
Raleigh, NC 27607-7505

Mailing address

1305 Walt Whitman Rd Ste 300
Melville, NY 11747-4300
Phone (866) 306-6007

Other practice location 1

801 Ostrum St
Bethlehem, PA 18015-1000
Phone (610) 954-5810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220128000257 MT Practitioner - Certified Registered Nurse Anesthetist (Crna) 4082901343 Reassigns benefits to 1 organization
I20240726003663 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 4082901343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Montana Gastroenterology, PLLCGroup PAC ID 7618396318, 23 clinicians

Practice addresses (Care Compare)

1930 W Broadway St
Suite a
Missoula, MT 59808-1960
Phone (406) 541-6844

Merit-based Incentive Payment System (MIPS)

Final score
90.28 of 100Reported as group
Quality
94
Promoting interoperability
100
Improvement activities
40
Cost
73.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
7392NCMDDentist
007392NCMDCertified Registered Nurse Anesthetist
RN575481PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Montana Gastroenterology, PLLC CurrentSince Jan 1, 2022 Accepting new patients
American Anesthesiology of North Carolina, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2024 Accepting new patients
American Anesthesiology of North Carolina, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2024 Accepting new patients
American Anesthesiology of North Carolina, PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

500 W Broadway St
Ste A
Missoula, MT 59802
Phone (406) 284-5560

1930 W Broadway St
Ste A
Missoula, MT 59808
Phone (406) 541-6844

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616
Phone (919) 882-0705

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1316328115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 WALT WHITMAN RD STE 300",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474300",
            "telephone_number": "866-306-6007",
            "fax_number": "704-248-5537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 LAKE BOONE TRL",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077505",
            "telephone_number": "919-784-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Ostrum St",
            "address_purpose": "LOCATION",
            "city": "Bethlehem",
            "state": "PA",
            "postal_code": "180151000",
            "country_code": "US",
            "telephone_number": "610-954-5810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JACLYN",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-17",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN575481",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "007392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.