NPIMap

Organization Active NPI

Miller Donmoyer Family Health Center LLC

  • Rural Health Clinic/Center
  • Shamokin, PA
National Provider Identifier
1346541935
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MILLER DONMOYER FAMILY HEALTH CENTER LLC
Practice address
255 W Spruce St
Shamokin, PA 17872-5811
Phone
(570) 644-5050
Fax
(570) 644-2798
NPI assigned
Nov 12, 2010
Last updated
Dec 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

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

Authorized official

Name
Wayne R Miller, MDNPI 1629039995
Title
Member
Phone
(570) 644-5050

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X PA Primary

Addresses

Primary practice location

255 W Spruce St
Shamokin, PA 17872-5811

Mailing address

255 W Spruce St
Shamokin, PA 17872-5811
Phone (570) 644-5050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110208000630 PA Part B Supplier - Clinic/Group Practice 1850571829 Receives reassigned benefits from 5 practitioners
Practice locations: Shamokin, PA
O20110208000966 PA Part A Provider - Rural Health Clinic 1850571829 Practice locations: Shamokin, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346541935. Details of each certification follow.

Rural health clinic certification: CCN 393857

Legal name
MILLER DONMOYER FAMILY HEALTH CENTER LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 5, 1995
Last certification
Mar 11, 2022
Ownership / control type
1C
Most recent change of ownership
Jan 1, 2011 (1 total)
Organization structure
LLCProprietary
Incorporated
Jan 1, 2011 in PA
Enrollment address
255 W Spruce St
Shamokin, PA 17872-5811

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Duane R Donmoyer Individual 5% Or Greater Direct Ownership Interest Jan 1, 2011 50%
Operational/Managerial ControlMember-Manager Jan 1, 2011 50%
OtherMember-Manager Jan 1, 2011 50%
Wayne R Miller Individual 5% Or Greater Direct Ownership Interest Jan 1, 2011 50%
Operational/Managerial ControlMember-Manager Jan 1, 2011 50%
OtherMember-Manager Jan 1, 2011 50%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1289520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1346541935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W SPRUCE ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178725811",
            "telephone_number": "570-644-5050",
            "fax_number": "570-644-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W SPRUCE ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178725811",
            "telephone_number": "570-644-5050",
            "fax_number": "570-644-2798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLER DONMOYER FAMILY HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-12",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "570-644-5050",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shamokin, PA

Sources for this page

Verify at the official NPI Registry.