Individual provider Active NPI

Timothy Isaac Miller

  • Clinical Pathology/Laboratory Medicine Physician
  • Fargo, ND
National Provider Identifier
1568923605
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
License
22190 Issued in ND
Practice address
4840 23Rd Ave S
Fargo, ND 58104-9136
Phone
(701) 417-6999
NPI assigned
Mar 29, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X MDRE.ML.60952186 WA
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 22190 ND Primary

Addresses

Primary practice location

4840 23Rd Ave S
Fargo, ND 58104-9136

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9419

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address timiller@uw.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20250818000792 ND Practitioner - Pathology 1153654546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MDRE.ML.60952186WAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Aug 11, 2025 Accepting new patients
Sanford Medical Center Fargo CurrentSince Aug 11, 2025 Accepting new patients

Locations

4840 23rd Ave S
Fargo, ND 58104
Phone (701) 234-4445

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1568923605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 23RD AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581049136",
            "telephone_number": "701-417-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "TIMOTHY",
        "middle_name": "ISAAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MDRE.ML.60952186",
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "ND",
            "license": "22190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "timiller@uw.edu",
            "affiliation": "N",
            "address_1": "1959 NE Pacific St",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981950001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.