NPIMap

Individual provider Active NPI

Edmund McLean Miller, D.O.

  • Family Medicine Physician
  • Tupelo, MS
National Provider Identifier
1689089203
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
24099 Issued in MS
Practice address
1665 S Green St
Tupelo, MS 38804-6556
Phone
(662) 377-2189
NPI assigned
Jun 23, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 24099 MS Primary

Addresses

Primary practice location

1665 S Green St
Tupelo, MS 38804-6556

Mailing address

1665 S Green St
Tupelo, MS 38804-6556
Phone (662) 377-2189

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20160328000378 MS Practitioner - Family PracticePractitioner - Emergency Medicine 0042517666 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
William Carey University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

5062 Raymond Ave
Tupelo, MS 38801-8671
Phone (662) 566-5593

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
24099MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Correct Care, Inc. CurrentSince Mar 1, 2016 Accepting new patients
North Mississippi Home Medical Equipment Company Current Accepting new patients
North Mississippi Medical Clinics Inc CurrentSince Mar 9, 2017 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms LLC CurrentSince Oct 1, 2017 Accepting new patients
North Mississippi Medical Clinics Inc CurrentSince Mar 9, 2017 Accepting new patients
North Mississippi Medical Clinics Inc Family Medicine Current Accepting new patients
North Mississippi Medical Center Current Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC CurrentSince Oct 1, 2017 Accepting new patients
Dugan Memorial Home, Inc. Past Accepting new patients

Locations

229 Saint John Ln
Covington, LA 70433
Phone (866) 875-9225

400 S Chestnut St
Aberdeen, MS 39730
Phone (662) 369-2455

40128 Hamilton Rd
Hamilton, MS 39746
Phone (662) 343-5129

845 S Madison St
Tupelo, MS 38801
Phone (601) 790-5025

5062 Raymond Ave
Tupelo, MS 38801
Phone (662) 566-5593

755 Emergency Dr
West Point, MS 39773
Phone (662) 494-8500

409 Tyler Holmes Dr
Winona, MS 38967
Phone (662) 283-3060

Interoperability endpoints

  • Direct secure messaging: emcleanmiller@nmhs.medalliesdirect.net

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
Clay County Medical CenterWest Point, MS, CCN 250067 Hospital Corporate Director Oct 1, 2018
Clay County Medical Center Swing BedWest Point, MS, CCN 25U067 Hospital Corporate Director Oct 1, 2018

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 9

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 10

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": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1689089203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1665 S GREEN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388046556",
            "telephone_number": "662-377-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 S GREEN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388046556",
            "telephone_number": "662-377-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "EDMUND",
        "middle_name": "MCLEAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "24099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.