Craig B Miller, M.D.
Individual provider Active NPI Family Medicine Physician · Plymouth, IN
NPI 1376571265 · NPPES record last updated Feb 19, 2024
Key facts
- NPI
- 1376571265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01050910 (IN)
- Practice address
- 2349 Lake Ave Ste 100
Plymouth, IN 46563-7836 - Phone
- (574) 948-5100
- Fax
- (574) 948-5499
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 5
Owned or controlled facilities with NPI records 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Indiana University School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Saint Joseph Regional Medical Center Inc
Practice addresses (Care Compare)
1919 Lake Ave
Plymouth, IN 46563-7830
2349 Lake Ave
Suite 100
Plymouth, IN 46563-7836
Phone (574) 948-5100
5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
60101 Bodnar Blvd
Suite 100B
Mishawaka, IN 46544-9340
Phone (574) 335-8800
611 E Douglas Rd
Mishawaka, IN 46545-1467
611 E Douglas Rd
309 Infectious Diseases
Mishawaka, IN 46545-1469
Phone (574) 335-6770
Hospital & facility affiliations
- Saint Joseph Vna Home Care
- Elara Caring
- Saint Joseph Regional Medical Center - Plymouth
- Saint Joseph Regional Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 12 |
| Removal of tissue | 71 |
| Removal of skin lesions | 62 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Saint Joseph Regional Medical Center - Plymouth |
Hospital | Corporate Director W-2 Managing Employee |
Jan 1, 2017 Jan 1, 2017 |
| Saint Joseph Regional Medical Center |
Hospital | Corporate Director W-2 Managing Employee |
Apr 21, 2022 Jan 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050412001164 | IN | Practitioner - Family Practice | 6305883299 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01050910 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center-South Bend Campus, Inc | Current |
Accepting new patients | |
| Saint Joseph Regional Medical Center-South Bend Campus, Inc. | Current |
Accepting new patients | |
| Saint Joseph Regional Medical Center, Inc. | Current | Accepting new patients | |
| HHC Indiana Inc. | Current |
Accepting new patients | |
| Saint Joseph Regional Medical Center-South Bend Campus, Inc | Current | Accepting new patients | |
| Saint Joseph Regional Medical Center- Plymouth Campus Inc | Family Medicine | Past | Accepting new patients |
| South Bend Psychiatry LLC | Past |
Accepting new patients | |
| Preferred Emergency Physicians | Past | Accepting new patients |
Locations
611 E Douglas Rd
Ste 309
Mishawaka, IN 46545
Phone (574) 335-6232
5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443
60101 Bodnar Blvd
Ste 100B
Mishawaka, IN 46544
Phone (574) 335-8500
1800 N Oak Dr
Plymouth, IN 46563
Phone (574) 303-5375
2349 Lake Ave
Ste 99
Plymouth, IN 46563
Phone (574) 948-5340
2349 Lake Ave
Ste 100
Plymouth, IN 46563
Phone (574) 941-3111
209 E Jefferson St
Plymouth, IN 46563
Phone (574) 941-3111
707 Cedar St
Ste 200
South Bend, IN 46617
Phone (574) 237-1328
616 E 13th St
Winamac, IN 46996
Phone (574) 946-2100
Interoperability endpoints
- cmiller1147699@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01050910 | IN | Yes |
Addresses
Primary practice location
2349 Lake Ave Ste 100
Plymouth, IN 46563-7836
Mailing address
707 Cedar St Ste 405
South Bend, IN 46617-2059
Phone (574) 335-8707
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200272700A | Medicaid | IN | |
| 1102406683 | Other | IN | ANTHEM |
Other providers in Plymouth, IN
- Kimberley Kay Mendez
- Bethany Metz
- Zoey Micek
- Michiana Eye Center LLC
- Michiana Hematology-Oncology P C
- Joy Miller
- Miller'S Health Systems, Inc.
- Mindfulness Counseling, LLC
- Jerrold Moore
- Cassidy Morris
All providers in Plymouth, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.