NPIMap

Individual provider Active NPI

Kenneth James Miller Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Miami, FL
National Provider Identifier
1366584641
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2777352 Issued in FL
Practice address
1400 NW 12TH Ave
Miami, FL 33136-1003
Phone
(305) 659-5841
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2777352 FL Primary

Addresses

Primary practice location

1400 NW 12TH Ave
Miami, FL 33136-1003

Mailing address

1400 NW 12TH Ave
Miami, FL 33136-1003
Phone (305) 659-5841

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070919000019 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8729172986 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lucie Anesthesia Associates LLCGroup PAC ID 4284792706, 79 clinicians

Practice addresses (Care Compare)

1801 W Sample Rd
Suite 200
Deerfield Beach, FL 33064-1370
Phone (954) 939-5000

Hospital & facility affiliations

  • Jackson Health System Hospital, Miami, FL, CCN 100022

Merit-based Incentive Payment System (MIPS)

Final score
91.01 of 100Reported as group
Quality
72.99
Promoting interoperability
82
Improvement activities
40
Cost
78.71

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2777352FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
St Lucie Anesthesia Associates LLC Current Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
St Lucie Anesthesia Associates LLC CurrentSince Oct 1, 2020 Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2025 Accepting new patients
St. Lucie Anesthesia Associates, LLC CurrentSince Oct 1, 2020 Accepting new patients
Volusia Anesthesia Associates Past Accepting new patients

Locations

1801 W Sample Rd
Ste 200
Deerfield Beach, FL 33064
Phone (954) 904-0723

1600 S Andrews Ave
Ft Lauderdale, FL 33316
Phone (954) 355-4000

3995 NW Goldenrod Rd
Jensen Beach, FL 34957
Phone (772) 497-0020

1800 SE Tiffany Ave
Port St Lucie, FL 34952
Phone (772) 398-1969

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 7

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 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368576000000",
    "number": "1366584641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 NW 12TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361003",
            "telephone_number": "305-659-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 NW 12TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331361003",
            "telephone_number": "305-659-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KENNETH",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2013-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "2777352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.