Individual provider Active NPI

Janis Deann Miller, NP

  • Nurse Practitioner
  • Greenup, IL
National Provider Identifier
1356401335
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2009006355 Issued in IL
Practice address
302 North Mill Street
Greenup, IL 62428
Phone
(217) 923-3311
Fax
(217) 923-5160
NPI assigned
Dec 11, 2006
Last updated
May 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71002505A IN
Nurse Practitioner 363L00000X 2009006355 IL Primary

Addresses

Primary practice location

302 North Mill Street
Greenup, IL 62428

Mailing address

302 North Mill Street
Greenup, IL 62428
Phone (217) 923-3311

Other identifiers 3

IdentifierTypeStateIssuer
209006355OtherILLICENSE
P00435500OtherINRR MEDICARE
200876860MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address janis.miller.1@9559.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070817000206 IL Practitioner - Nurse Practitioner 5597857797 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Illinois Healthcare Foundation IncGroup PAC ID 1456256874, shared by 35 NPIs, 117 clinicians

Practice addresses (Care Compare)

626 W Lincoln Ave
Charleston, IL 61920-2444
Phone (217) 345-7702

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2009006355ILMDNurse Practitioner
71002505AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Healthcare Foundation, Inc. Family CurrentSince Aug 23, 2016 Accepting new patients
Southern Illinois Healthcare Foundation Inc Current Accepting new patients
Southern Illinois Healthcare Foundation Inc CurrentSince Aug 23, 2016 Accepting new patients
Union Hospital, Inc. Past Accepting new patients

Locations

302 N Mill St
Greenup, IL 62428
Phone (217) 923-3311

2041 Goose Lake Rd
Sauget, IL 62206

Interoperability endpoints

  • Direct secure messaging: janis.miller.1@9559.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1356401335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 NORTH MILL STREET",
            "city": "GREENUP",
            "state": "IL",
            "postal_code": "62428",
            "telephone_number": "217-923-3311",
            "fax_number": "217-923-5160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 NORTH MILL STREET",
            "city": "GREENUP",
            "state": "IL",
            "postal_code": "62428",
            "telephone_number": "217-923-3311",
            "fax_number": "217-923-5160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JANIS",
        "middle_name": "DEANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71002505A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "2009006355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "209006355",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00435500",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200876860",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "janis.miller.1@9559.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "302 North Mill Street",
            "city": "Greenup",
            "state": "IL",
            "country_code": "US",
            "postal_code": "62428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenup, IL

Sources for this page

Verify at the official NPI Registry.