Active NPI
Timothy Michael Miller, LSW, LICDC-S
- Addiction Medicine (Psychiatry & Neurology) Physician
- Columbus, OH
National Provider Identifier
1528694643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician
- License
- 001104
- Practice address
- 1441 Phale D. Hale Dr.
Columbus, OH 43203 - Phone
- (614) 257-3754
- NPI assigned
- Mar 20, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | 001104 | OH | Primary |
Addresses
Primary practice location
1441 Phale D. Hale Dr.
Columbus, OH 43203
Mailing address
11122 Gorsuch Rd
Galena, OH 43021-9633
Phone (419) 203-9314
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | ||
| 101010101 | Other | 1010101 |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | timothy.miller2@osumc.edu | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001104 | OH | MD | Addiction Medicine (Psychiatry & Neurology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1528694643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11122 GORSUCH RD",
"city": "GALENA",
"state": "OH",
"postal_code": "430219633",
"telephone_number": "419-203-9314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1441 PHALE D. HALE DR.",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43203",
"telephone_number": "614-257-3754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "TIMOTHY",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "LSW, LICDC-S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-20",
"last_updated": "2022-07-21",
"certification_date": "2020-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "OH",
"license": "001104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": null,
"identifier": "NONE",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "1010101",
"identifier": "101010101",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "timothy.miller2@osumc.edu",
"affiliation": "N",
"endpointDescription": "business email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "1441 Phale D. Hale Dr.",
"city": "Columbus",
"state": "OH",
"country_code": "US",
"postal_code": "43203",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.