Active NPI
Abigale Miller
- Dentist
- Elkhart, IN
National Provider Identifier
1366892382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12012543A
- Practice address
- 505 Vistula St
Elkhart, IN 46516-2809 - Phone
- (574) 293-2003
- Fax
- (574) 294-6131
- NPI assigned
- Jun 21, 2016
- Last updated
- Jun 21, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12012543A | IN | Primary |
Addresses
Primary practice location
505 Vistula St
Elkhart, IN 46516-2809
Mailing address
505 Vistula St
Elkhart, IN 46516-2809
Phone (574) 293-2003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 12, 2017 through Oct 12, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012543A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1366892382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 VISTULA ST",
"city": "ELKHART",
"state": "IN",
"postal_code": "465162809",
"telephone_number": "574-293-2003",
"fax_number": "574-294-6131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 VISTULA ST",
"city": "ELKHART",
"state": "IN",
"postal_code": "465162809",
"telephone_number": "574-293-2003",
"fax_number": "574-294-6131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "ABIGALE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-21",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12012543A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.