Individual provider Active NPI

Lisa Ann Miller, PA

  • Physician Assistant
  • Vero Beach, FL
National Provider Identifier
1407824675
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9102983 Issued in FL
Practice address
1000 36TH St
Vero Beach, FL 32960-4862
Phone
(772) 567-4311
NPI assigned
Mar 14, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9102983 FL Primary

Addresses

Primary practice location

1000 36TH St
Vero Beach, FL 32960-4862

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other practice location 1

13695 US Highway 1
Sebastian, FL 32958-3230
Phone (772) 589-3186

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20041103000189 FL Practitioner - Physician Assistant 7214999044 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palm Beach General Surgery LLCGroup PAC ID 1456455021, 69 clinicians

Practice addresses (Care Compare)

1700 S 23Rd St
Fort Pierce, FL 34950-4803
Phone (772) 462-4100

1825 SE Tiffany Ave
Port Saint Lucie, FL 34952-7554
Phone (772) 335-4000

2402 Frist Blvd
Fort Pierce, FL 34950-4838

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Mar 2, 2024 Accepting new patients
Steward Medical Group, Inc. CurrentSince Mar 2, 2024 Accepting new patients
Emergency Medicine Associates Inc Past Accepting new patients
Physician Assistant Services of the Treasure Coast Past Accepting new patients
Stewart and Stewart a Medical Corporation Past Accepting new patients
Palm Beach General Surgery LLC Past Accepting new patients
Pelican Coast Emergency Physicians LLC Past Accepting new patients

Locations

250 N Wickham Rd
Melbourne, FL 32935
Phone (321) 637-2600

13695 US Highway 1
Sebastian, FL 32958
Phone (772) 589-3185

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 10

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 1

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": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1407824675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 36TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604862",
            "telephone_number": "772-567-4311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13695 US Highway 1",
            "address_purpose": "LOCATION",
            "city": "Sebastian",
            "state": "FL",
            "postal_code": "329583230",
            "country_code": "US",
            "telephone_number": "772-589-3186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "LISA",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

Verify at the official NPI Registry.