Individual provider Active NPI

Dakotah Miller

  • Physician Assistant
  • Fort Wayne, IN
National Provider Identifier
1689465130
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10005196A Issued in IN
Practice address
11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone
(260) 739-9737
NPI assigned
May 14, 2025
Last updated
Jul 10, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10005196A IN Primary
Physician Assistant 363A00000X 50.010126RX OH

Addresses

Primary practice location

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701

Mailing address

608 Union Chapel Rd
Fort Wayne, IN 46845-9357

Other practice location 1

2200 Randallia Dr
Fort Wayne, IN 46805-4699
Phone (260) 373-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20260217000705 IN Practitioner - Physician Assistant 2264912419 Reassigns benefits to 2 organizations
I20260227001450 OH Practitioner - Physician Assistant 2264912419 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Emergency Physicians PCGroup PAC ID 2769384213, 79 clinicians

Practice addresses (Care Compare)

2200 Randallia Dr
Fort Wayne, IN 46805-4638
Phone (260) 373-4000

433 W High St
Bryan, OH 43506-1690
Phone (419) 636-1131

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10005196AINMDPhysician Assistant
50.010126RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Emergency Physicians PC Physician Assistant CurrentSince Mar 1, 2026 Accepting new patients

Locations

11109 Parkview Plaza Dr
Fort Wayne, IN 46845
Phone (260) 266-2020

2200 Randallia Dr
Fort Wayne, IN 46805
Phone (260) 373-4000

608 Union Chapel Rd
Fort Wayne, IN 46845
Phone (260) 482-4440

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1747180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1689465130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 UNION CHAPEL RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468459357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701",
            "telephone_number": "260-739-9737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 Randallia Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468054699",
            "country_code": "US",
            "telephone_number": "260-373-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "DAKOTAH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-14",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005196A",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.010126RX",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.