NPIMap

Individual provider Active NPI

Wayne Robert Miller, MD

  • Internal Medicine Physician
  • Shamokin, PA
National Provider Identifier
1629039995
Registry record updated Feb 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD042431L Issued in PA
Practice address
255 W Spruce St
Shamokin, PA 17872-5811
Phone
(570) 644-5050
Fax
(570) 644-2798
NPI assigned
Mar 28, 2006
Last updated
Feb 22, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD042431L PA Primary

Addresses

Primary practice location

255 W Spruce St
Shamokin, PA 17872-5811

Mailing address

255 W Spruce St
Shamokin, PA 17872-5811
Phone (570) 644-5050

Other identifiers 1

IdentifierTypeStateIssuer
001206879MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20081124000082 PA Practitioner - Internal Medicine 9234299058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Perelman School of Med at the University of Pennsylvania, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Miller Donmoyer Family Health Center LLCGroup PAC ID 1850571829, 4 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

255 W Spruce St
Shamokin, PA 17872-5811
Phone (570) 644-5050

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Mobile X-Ray, Inc CurrentSince Sep 25, 2024 Accepting new patients
Miller Donmoyer Family Health Center LLC CurrentSince Jan 1, 2011 Accepting new patients
Mountain View Nursing, LP Past Accepting new patients
Geisinger Medical Center Past Accepting new patients
2050 Trevorton Road Opco LLC Past Accepting new patients

Locations

255 W Spruce St
Shamokin, PA 17872
Phone (570) 644-5050

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mountain View Rehabilitation and Senior Living CenterCoal Township, PA, CCN 395045 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body		 Jan 1, 2025
Jan 1, 2025
Miller Donmoyer Family Health Center LLCShamokin, PA, CCN 393857 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control (50%)
Other (50%)		 Jan 1, 2011
Jan 1, 2011
Jan 1, 2011

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 35

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 35

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329868800000",
    "number": "1629039995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W SPRUCE ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178725811",
            "telephone_number": "570-644-5050",
            "fax_number": "570-644-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W SPRUCE ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178725811",
            "telephone_number": "570-644-5050",
            "fax_number": "570-644-2798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "WAYNE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2012-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD042431L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001206879",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shamokin, PA

Sources for this page

Verify at the official NPI Registry.