NPIMap

Individual provider Active NPI

Kwon T. Miller, D.O.

  • Cardiovascular Disease Physician
  • Youngstown, OH
National Provider Identifier
1316900848
Registry record updated Oct 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
34009913 Issued in OH
Practice address
715 E Western Reserve Rd
Youngstown, OH 44514-3358
Phone
(330) 726-3204
Fax
(330) 729-9316
NPI assigned
Apr 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X OS012150 PA
Cardiovascular Disease Physician 207RC0000X 34009913 OH Primary

Addresses

Primary practice location

715 E Western Reserve Rd
Youngstown, OH 44514-3358

Mailing address

PO Box 636988
Cincinnati, OH 45263-6988
Phone (888) 940-2722

Other identifiers 4

IdentifierTypeStateIssuer
3074766MedicaidOH
4303762OtherOHMEDICARE PTAN
001947190MedicaidPA
0019616090004MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101028000470 OH Practitioner - Cardiovascular Disease (Cardiology) 3375579899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Philadelphia College of Osteopathic Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

715 E Western Reserve Rd
Poland, OH 44514-3358
Phone (330) 726-3204

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34009913OHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Youngstown Specialty Care LLC Cardiovascular Disease CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown Specialty Care LLC CurrentSince Jan 1, 2022 Accepting new patients
Mercy Health Physicians Youngstown, LLC Cardiovascular Disease Past Accepting new patients

Locations

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

1001 Belmont Ave
Youngstown, OH 44504
Phone (330) 747-1106

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

715 E Western Reserve Rd
Youngstown, OH 44514
Phone (330) 726-3204

Interoperability endpoints

  • Direct secure messaging: kmiller26584@direct.bsmhealth.org

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443744000000",
    "number": "1316900848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636988",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636988",
            "telephone_number": "888-940-2722",
            "fax_number": "513-632-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E WESTERN RESERVE RD",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445143358",
            "telephone_number": "330-726-3204",
            "fax_number": "330-729-9316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KWON",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2015-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "OS012150",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "34009913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3074766",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "4303762",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001947190",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019616090004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.