NPIMap

Organization Active NPI

Miller Orthopaedic Affiliates PC

  • Orthopaedic Surgery Physician
  • Council Bluffs, IA
National Provider Identifier
1659379519
Registry record updated Jul 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
MILLER ORTHOPAEDIC AFFILIATES PC
Practice address
1 Edmundson Place
Suite 500
Council Bluffs, IA 51503-4619
Phone
(712) 323-5333
Fax
(712) 323-3252
NPI assigned
Jul 13, 2005
Last updated
Jul 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2012

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

Authorized official

Name
Dr. Daniel J. Larose, MDNPI 1730187410
Title
President
Phone
(712) 323-5333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary
Foot & Ankle Surgery Podiatrist 213ES0103X NU
Orthopedic Physical Therapist 2251X0800X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU
Customized Equipment (DME) 332BC3200X NU
Prosthetic/Orthotic Supplier 335E00000X NU
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

1 Edmundson Place
Suite 500
Council Bluffs, IA 51503-4619

Mailing address

1 Edmundson PL
Ste 500
Council Bluffs, IA 51503-4619
Phone (712) 323-5333

Other identifiers 7

IdentifierTypeStateIssuer
0701830MedicaidIA
09602OtherIAWELLMARK GRP #
0701873MedicaidIA
0119040MedicaidIA
0701871MedicaidIA
0701872MedicaidIA
10025346400MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040312001239 IA Part B Supplier - Clinic/Group Practice 4385533769 Receives reassigned benefits from 8 practitioners
Practice locations: Audubon, IA; Clarinda, IA; Corning, IA; Council Bluffs, IA; Denison, IA; Harlan, IA; Manning, IA; Red Oak, IA
O20041122000880 NE Part B Supplier - Clinic/Group Practice 4385533769 Receives reassigned benefits from 6 practitioners
Practice locations: Omaha, NE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1659379519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EDMUNDSON PL",
            "address_2": "STE 500",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034619",
            "telephone_number": "712-323-5333",
            "fax_number": "712-323-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EDMUNDSON PLACE",
            "address_2": "SUITE 500",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034619",
            "telephone_number": "712-323-5333",
            "fax_number": "712-323-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLER ORTHOPAEDIC AFFILIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "LAROSE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-323-5333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0701830",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK GRP #",
            "identifier": "09602",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0701873",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0119040",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0701871",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0701872",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025346400",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.