NPIMap

Individual provider Active NPI

Mark L Miller, D.O.

  • Family Medicine Physician
  • Louisville, KY
National Provider Identifier
1558474130
Registry record updated Mar 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02963 Issued in KY
Practice address
4521 Outer Loop
Louisville, KY 40219-3856
Phone
(502) 653-5206
Fax
(877) 688-0102
NPI assigned
Aug 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02963 KY Primary

Addresses

Primary practice location

4521 Outer Loop
Louisville, KY 40219-3856

Mailing address

6101 Blue Lagoon Dr Ste 200
Miami, FL 33126-3168

Other practice location 1

329 Floyd Dr
Carrollton, KY 41008-8261
Phone (502) 732-1082

Other identifiers 4

IdentifierTypeStateIssuer
000000526905OtherKYANTHEM
64123722MedicaidKY
50014320OtherKYPASSPORT
2831247000OtherKYPASSPORT ADVANTAGE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mark.miller.1@29601.direct.athenahealth.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070322000187 KY Practitioner - Family Practice 7214031715 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Homeopathic Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

329 Floyd Dr
Carrollton, KY 41008-8261

6101 Blue Lagoon Dr
Suite 200
Miami, FL 33126

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centerwell Senior Primary Care in PC Family Medicine Current Accepting new patients
Centerwell Senior Primary Care Ky PSC Family Medicine CurrentSince Dec 5, 2022 Accepting new patients
Centerwell Senior Primary Care Ky PSC Family Medicine Current Accepting new patients
Centerwell Senior Primary Care in PC Family Medicine CurrentSince Sep 1, 2023 Accepting new patients
Centerwell Senior Primary Care (Ky) PSC Family Medicine CurrentSince Dec 5, 2022 Accepting new patients
Centerwell Senior Primary Care in PC Family Medicine CurrentSince Sep 1, 2023 Accepting new patients

Locations

6101 Waterford District Dr
Ste 200
Miami, FL 33126
Phone (407) 533-6836

1020 Veterans Pkwy
Ste 700
Clarksville, IN 47129
Phone (812) 668-8144

305 New Albany Plz
New Albany, IN 47150
Phone (812) 668-8133

4521 Outer Loop
Louisville, KY 40219
Phone (502) 653-5206

3151 S 2nd St
Louisville, KY 40208
Phone (502) 632-9313

Organizations & group practices 7

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 37

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1558474130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 BLUE LAGOON DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331263168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4521 OUTER LOOP",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402193856",
            "telephone_number": "502-653-5206",
            "fax_number": "877-688-0102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "329 Floyd Dr",
            "address_purpose": "LOCATION",
            "city": "Carrollton",
            "state": "KY",
            "postal_code": "410088261",
            "country_code": "US",
            "telephone_number": "502-732-1082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MARK",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "02963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000526905",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64123722",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT",
            "identifier": "50014320",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2831247000",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mark.miller.1@29601.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "4521 Outer Loop",
            "city": "Louisville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "402193856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.