Individual provider Active NPI

Mark A Miller, M.D.

  • Otolaryngology Physician
  • Medford, OR
National Provider Identifier
1689025827
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD204536 Issued in OR
Practice address
1170 Royal Ave
Medford, OR 97504-6101
Phone
(541) 779-7331
Fax
(541) 779-3522
NPI assigned
Jun 29, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD204536 OR Primary

Addresses

Primary practice location

1170 Royal Ave
Medford, OR 97504-6101

Mailing address

1170 Royal Ave
Medford, OR 97504-6101
Phone (541) 779-7331

Other identifiers 1

IdentifierTypeStateIssuer
500793096MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20210802003512 OR Practitioner - Otolaryngology 3173818457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medford Ear Nose and Throat Clinic PCGroup PAC ID 1355338013, 8 clinicians

Practice addresses (Care Compare)

1170 Royal Ave
Medford, OR 97504-6101
Phone (541) 779-7331

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medford Ear Nose and Throat Clinic PC Otolaryngology CurrentSince Jul 19, 2021 Accepting new patients

Locations

1170 Royal Ave
Medford, OR 97504
Phone (541) 512-4771

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1689025827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 ROYAL AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046101",
            "telephone_number": "541-779-7331",
            "fax_number": "402-559-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 ROYAL AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046101",
            "telephone_number": "541-779-7331",
            "fax_number": "541-779-3522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-29",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OR",
            "license": "MD204536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500793096",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.