Individual provider Active NPI

Jennifer Lee Miller, MSN, FNP-C

  • Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1710461967
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
345294 Issued in NY
Practice address
2960 Victory Blvd
Staten Island, NY 10314-6605
Phone
(718) 370-2014
NPI assigned
Sep 23, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9315881 FL
Nurse Practitioner 363L00000X 345294 NY Primary

Addresses

Primary practice location

2960 Victory Blvd
Staten Island, NY 10314-6605

Mailing address

770 Jackson St Apt 1105
Hoboken, NJ 07030-6991
Phone (813) 474-6319

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20200807001167 NY Practitioner - Nurse Practitioner 8022433093 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excel Urgent Care of Wantagh PLLCGroup PAC ID 9234364027, 40 clinicians

Practice addresses (Care Compare)

2960 Victory Blvd
Staten Island, NY 10314-6605
Phone (718) 370-2014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9315881FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Excel Urgent Care of Wantagh PLLC CurrentSince Sep 5, 2022 Accepting new patients
Optum Urgent Care, PLLC CurrentSince May 1, 2020 Accepting new patients

Locations

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

2800 Marcus Ave
New Hyde Park, NY 11042
Phone (516) 622-6131

484 Temple Hill Rd
Ste 103
New Windsor, NY 12553

2960 Victory Blvd
Staten Island, NY 10314
Phone (718) 370-2014

3894 Richmond Ave
Staten Island, NY 10312
Phone (347) 630-7985

3430 Sunrise Hwy
Wantagh, NY 11793
Phone (516) 900-1600

Interoperability endpoints

  • Direct secure messaging: jennifer.miller.1@14883.direct.athenahealth.com

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": "1537660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1710461967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 JACKSON ST APT 1105",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070306991",
            "telephone_number": "813-474-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146605",
            "telephone_number": "718-370-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "credential": "MSN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-23",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9315881",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "345294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.