Michael Miller, MD
Individual provider Active NPI Family Medicine Physician · Fulton, NY
NPI 1588045488 · NPPES record last updated Sep 14, 2018
Key facts
- NPI
- 1588045488
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 296061 (NY)
- Practice address
- 510 S 4TH St Ste 600
Fulton, NY 13069-2904 - Phone
- (315) 598-4790
- NPI assigned
- Jun 16, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northern Oswego County Health Services, Inc.
Practice addresses (Care Compare)
510 S 4TH St
Suite 600
Fulton, NY 13069-2952
Phone (315) 598-4790
Hospital & facility affiliations
- Oswego Health Home Care, LLC
- Oswego Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181022002883 | NY | Practitioner - Family Practice | 8921351982 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 296061 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Oswego County Health Services, Inc. | Current |
Accepting new patients | |
| The Maples Adult Living Community | Past | Accepting new patients |
Locations
510 S 4th St
Ste 600
Fulton, NY 13069
Phone (315) 598-4790
61 Delano St
Pulaski, NY 13142
Phone (315) 298-4274
Interoperability endpoints
- michael.miller@nochsi.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 296061 | NY | Yes |
Addresses
Primary practice location
510 S 4TH St Ste 600
Fulton, NY 13069-2904
Mailing address
61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6569
Other providers in Fulton, NY
- Zachary Adam Merry
- Mexico Academy and Central School District
- Michaud Residential Health Services Inc
- Hannah Midlar
- Jacob Michael Miller
- Laurie Jean Mills
- Edward Kevin Mock Jr.
- Mohamed Ahmed Physicians PC
- Angela Monty
- Hannah Grace Moore
All providers in Fulton, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2018. 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.