NPIMap

Individual provider Active NPI

Theresa B Miller, P.A

  • Physician Assistant
  • Rochester Hills, MI
National Provider Identifier
1609028356
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005403 Issued in MI
Practice address
1555 South Blvd E Ste 390
Rochester Hills, MI 48307-5624
Phone
(248) 267-5790
Fax
(248) 267-5799
NPI assigned
Oct 14, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601005403 MI Primary

Addresses

Primary practice location

1555 South Blvd E Ste 390
Rochester Hills, MI 48307-5624

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address tmiller24856@direct.beaumont.edu
Direct Messaging Address tmiller24856@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20081119000485 MI Practitioner - Physician Assistant 2769542869 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1555 S Blvd E
390 Beaumont General and Venous Surgery
Rochester Hills, MI 48307-5624
Phone (248) 267-5015

28100 Grand River Ave
Farmington Hills, MI 48336-5970

44201 Dequindre Rd
Troy, MI 48085-1117
Phone (248) 964-0535

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601005403MIMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: tmiller24856@direct.beaumont.edu
  • Direct secure messaging: tmiller1247020@epic00.shdirect.org

Organizations & group practices 2

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 12

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": "1223942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1609028356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SOUTH BLVD E STE 390",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483075624",
            "telephone_number": "248-267-5790",
            "fax_number": "248-267-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "THERESA",
        "middle_name": "B",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-14",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmiller24856@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "1701 South Blvd E",
            "address_2": "Suite 200",
            "city": "Rochester Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483076122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmiller24856@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "1555 South Blvd E Ste 390",
            "city": "Rochester Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483075624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rochester Hills, MI

Sources for this page

Verify at the official NPI Registry.