Individual provider Active NPI

Jerry J Miller, MD

  • Dermatology Physician
  • Menomonee Falls, WI
National Provider Identifier
1497758049
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
30596 Issued in WI
Practice address
N84W16889 Menomonee Ave
Menomonee Falls, WI 53051-2810
Phone
(262) 251-7500
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 30596 WI Primary

Addresses

Primary practice location

N84W16889 Menomonee Ave
Menomonee Falls, WI 53051-2810

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

1440 N 25th St
Sheboygan, WI 53081-3108
Phone (920) 457-9100

Other practice location 2

111 Wisconsin American Dr
Fond Du Lac, WI 54937-6725
Phone (920) 923-0788

Other identifiers 1

IdentifierTypeStateIssuer
1497758049MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jmiller413111@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040910000553 WI Practitioner - Dermatology 8426025461 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Wisconsin School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Advanced Healthcare, Inc.Group PAC ID 3375625833, 1,107 clinicians

Practice addresses (Care Compare)

N84 W16889 Menomonee Ave
Menomonee Falls, WI 53051-2810
Phone (262) 251-7500

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions70
Removal or shaving of skin growth40
Skin biopsy84

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
30596WIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Advanced Healthcare Inc CurrentSince Nov 1, 2024 Accepting new patients
Aurora Advanced Healthcare, Inc. Dermatology CurrentSince Nov 1, 2024 Accepting new patients

Locations

3003 W Good Hope Rd
Glendale, WI 53209
Phone (414) 352-3100

N84W16889 Menomonee Ave
Menomonee Fls, WI 53051
Phone (262) 251-7500

12203 N Corporate Pkwy
Mequon, WI 53092
Phone (262) 387-8200

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1497758049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N84W16889 MENOMONEE AVE",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530512810",
            "telephone_number": "262-251-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1440 N 25th St",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530813108",
            "country_code": "US",
            "telephone_number": "920-457-9100",
            "fax_number": "920-457-1461",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Wisconsin American Dr",
            "address_purpose": "LOCATION",
            "city": "Fond Du Lac",
            "state": "WI",
            "postal_code": "549376725",
            "country_code": "US",
            "telephone_number": "920-923-0788",
            "fax_number": "920-273-0085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JERRY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "30596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497758049",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmiller413111@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "N84W16889 Menomonee Ave",
            "city": "Menomonee Falls",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530512810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "N84W16889 Menomonee Ave",
            "city": "Menomonee Falls",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530512810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Menomonee Falls, WI

Sources for this page

Verify at the official NPI Registry.