Individual provider Active NPI

Laurel K Miller, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Escondido, CA
National Provider Identifier
1598992133
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
20378 Issued in CA
Practice address
555 E Valley Pkwy
Emergency Department
Escondido, CA 92025-3048
Phone
(760) 739-3301
NPI assigned
Jun 22, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 20378 CA Primary

Addresses

Primary practice location

555 E Valley Pkwy
Emergency Department
Escondido, CA 92025-3048

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Other practice location 1

4725 Market St
San Diego, CA 92102-4715
Phone (619) 515-2560

Other identifiers 2

IdentifierTypeStateIssuer
PA 20378OtherCAPA LICENSE
1087363OtherCANCCPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091208000478 CA Practitioner - Physician Assistant 2062551831 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc CurrentSince Aug 13, 2022 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Aug 13, 2022 Accepting new patients

Locations

4725 Market St
San Diego, CA 92102
Phone (619) 515-2560

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 5

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": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668124800000",
    "number": "1598992133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300",
            "fax_number": "619-906-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E VALLEY PKWY",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253048",
            "telephone_number": "760-739-3301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4725 Market St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921024715",
            "country_code": "US",
            "telephone_number": "619-515-2560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "LAUREL",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-22",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "20378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA 20378",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1087363",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Escondido, CA

Sources for this page

Verify at the official NPI Registry.