Nicolas Miller
Individual provider Active NPI Physician Assistant · Manhattan, IL
NPI 1457024754 · NPPES record last updated Feb 29, 2024
Key facts
- NPI
- 1457024754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 15255 Kenmare Cir
Manhattan, IL 60442-1441 - Phone
- (815) 342-8682
- NPI assigned
- Aug 1, 2021
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Midwestern University, Chicago College of Osteopathic Med, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prime Healthcare Illinois Medical Group LLC
Practice addresses (Care Compare)
100 N River Rd
Des Plaines, IL 60016-1209
Phone (847) 297-1800
100 Provena Way
Suite 103
Bourbonnais, IL 60914-4797
Phone (815) 937-8780
455 W Court St
Kankakee, IL 60901-3695
656 N Convent St
Bourbonnais, IL 60914-1393
Hospital & facility affiliations
- Presence St Marys Hospital
- Riverside Medical Center
- Osf Saint Elizabeth MDL Ctr
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220110001546 | IL | Practitioner - Physician Assistant | 5890187546 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | IL | Yes |
Addresses
Primary practice location
15255 Kenmare Cir
Manhattan, IL 60442-1441
Mailing address
15255 Kenmare Cir
Manhattan, IL 60442-1441
Phone (815) 342-8682
Other providers in Manhattan, IL
- Nicole McDonald
- Meghann McDonnell
- Alicia McLaughlin
- Catherine Marie Mendenhall
- Kelly Morgan Meyer
- Joseph Newtoff
- Tina Nolan
- Joann Orr
- Marlene Ariel Ortega
- Jaime L Pac
All providers in Manhattan, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 29, 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.
- 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.