Individual provider Active NPI

Kathryn Margaret Millar, PA-C

  • Physician Assistant
  • Southlake, TX
National Provider Identifier
1700404530
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA17407 Issued in TX
Practice address
261 W Southlake Blvd
Southlake, TX 76092-7046
Phone
(877) 506-3642
NPI assigned
Jul 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA17407 TX Primary

Addresses

Primary practice location

261 W Southlake Blvd
Southlake, TX 76092-7046

Mailing address

261 W Southlake Blvd
Southlake, TX 76092-7046
Phone (877) 506-3642

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20240214001236 TX Practitioner - Physician Assistant 5092159459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aaron C Eubanks MD PAGroup PAC ID 1456620491, 2 clinicians

Practice addresses (Care Compare)

261 W Southlake Blvd
Southlake, TX 76092-6103
Phone (817) 310-8783

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Spine Solutions PA CurrentSince Jan 21, 2024 Accepting new patients

Locations

261 W Southlake Blvd
Ste 100
Southlake, TX 76092

261 W Southlake Blvd
Southlake, TX 76092
Phone (817) 310-8783

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1700404530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 W SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927046",
            "telephone_number": "877-506-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 W SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927046",
            "telephone_number": "877-506-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLAR",
        "first_name": "KATHRYN",
        "middle_name": "MARGARET",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-08",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA17407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

Verify at the official NPI Registry.