Individual provider Active NPI

Kirk Miller, PA-C

  • Physician Assistant
  • Montrose, IL
National Provider Identifier
1629515606
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006955 Issued in IL
Practice address
16985 N 2400TH St
Montrose, IL 62445-5004
Phone
(217) 259-3849
NPI assigned
Jan 27, 2017
Last updated
Mar 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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 085006955 IL Primary

Addresses

Primary practice location

16985 N 2400TH St
Montrose, IL 62445-5004

Mailing address

16985 N 2400TH St
Montrose, IL 62445-5004
Phone (217) 259-3849

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20190326001627 IL Practitioner - Physician Assistant 1456623230 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Saint Anthonys Way
Alton, IL 62002-4568
Phone (618) 465-2571

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

503 N Maple St
Effingham, IL 62401-2006
Phone (217) 342-2121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
96.63
Improvement activities
40
Cost
81.81

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085006955ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America Illinois Intensivists CurrentSince Mar 1, 2019 Accepting new patients
Cep America-Illinois Hospitalists CurrentSince Mar 1, 2019 Accepting new patients
Cep America-Illinois Hospitalists, LLP CurrentSince Mar 1, 2019 Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4500 Memorial Dr
Belleville, IL 62226
Phone (618) 233-7750

503 N Maple St
Effingham, IL 62401
Phone (217) 342-2121

200 Health Care Dr
Greenville, IL 62246
Phone (618) 664-0808

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1485475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1629515606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16985 N 2400TH ST",
            "city": "MONTROSE",
            "state": "IL",
            "postal_code": "624455004",
            "telephone_number": "217-259-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16985 N 2400TH ST",
            "city": "MONTROSE",
            "state": "IL",
            "postal_code": "624455004",
            "telephone_number": "217-259-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KIRK",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-27",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montrose, IL

Sources for this page

Verify at the official NPI Registry.