Clyde Kennedy Miller, M.D.
Individual provider Active NPI Family Medicine Physician · Hatch, NM
NPI 1619172848 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619172848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD2007-0136 (NM)
- Practice address
- 255 Hwy 187
Hatch, NM 87937-0370 - Phone
- (505) 267-3286
- Fax
- (505) 267-1747
- NPI assigned
- Jun 18, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ben Archer Health Center
Practice addresses (Care Compare)
255 Hwy 187
Hatch, NM 87937
Phone (575) 267-3280
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- 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 |
|---|---|---|---|---|
| I20070813000196 | NM | Practitioner - Family Practice | 4385735810 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD2007-0136 | NM | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ben Archer Health Center | Current | Accepting new patients | |
| Cura Healthcare | Family Medicine | Current |
Accepting new patients |
| Ben Archer Health Center | Current |
Accepting new patients | |
| Ben Archer Health Center | Past | Accepting new patients |
Locations
8226 Menaul Blvd NE
Albuquerque, NM 87110
Phone (505) 413-3719
1600 Thorpe Rd
Las Cruces, NM 88012
Phone (505) 267-3088
1960 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-7662
1950 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-8057
7683 SE 27th St
Mercer Island, WA 98040
Phone (206) 228-8530
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD2007-0136 | NM | Yes |
Addresses
Primary practice location
255 Hwy 187
Hatch, NM 87937-0370
Mailing address
PO Box 370
Hatch, NM 87937-0370
Phone (505) 267-3286
Other providers in Hatch, NM
- James A Lopez
- Fernando Lugo
- Sharon Rae Lundin
- Enrique Martinez
- Richard Mathias
- Raquel Neeley
- Alejandra Ochoa
- Anna Karen Olvera
- Samantha Palos
- Reyna K Ramirez
All providers in Hatch, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.