Individual provider Active NPI

Mikaela Grace Miller

  • Psychiatry Physician
  • Bend, OR
National Provider Identifier
1639752355
Registry record updated Oct 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD226507 Issued in OR
Practice address
1128 NW Harriman St
Bend, OR 97703-1947
Phone
(541) 322-7500
Fax
(541) 322-7565
NPI assigned
Apr 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD226507 OR Primary

Addresses

Primary practice location

1128 NW Harriman St
Bend, OR 97703-1947

Mailing address

2577 NE Courtney Dr
Bend, OR 97701-7638
Phone (541) 322-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230915001051 CA Practitioner - Psychiatry 3072977685 Reassigns benefits to 1 organization
I20251216003454 OR Practitioner - Psychiatry 3072977685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Texas Medical School at San Antonio, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Deschutes County OregonGroup PAC ID 9638083371, 58 clinicians

Practice addresses (Care Compare)

2577 NE Courtney Dr
Bend, OR 97701-7638
Phone (541) 322-7400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD226507ORMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deschutes County Oregon CurrentSince Dec 4, 2025 Accepting new patients
Deschutes County Oregon CurrentSince Dec 4, 2025 Accepting new patients
Community Research Foundation Inc CurrentSince Jul 9, 2023 Accepting new patients

Locations

1196 Third Ave
Chula Vista, CA 91911
Phone (619) 382-6393

545 Laurel St
San Diego, CA 92101
Phone (619) 233-4399

1202 Morena Blvd
Ste 100
San Diego, CA 92110
Phone (619) 276-8112

1202 Morena Blvd
Ste 300
San Diego, CA 92110
Phone (619) 276-8112

2577 NE Courtney Dr
Bend, OR 97701
Phone (541) 322-7400

1128 NW Harriman St
Bend, OR 97703
Phone (541) 322-7457

Organizations & group practices 3

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": "1619740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759881600000",
    "number": "1639752355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2577 NE COURTNEY DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017638",
            "telephone_number": "541-322-7500",
            "fax_number": "541-322-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 NW HARRIMAN ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977031947",
            "telephone_number": "541-322-7500",
            "fax_number": "541-322-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MIKAELA",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-30",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD226507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.