Individual provider Active NPI

Nicole Miller, D.O.

  • Anatomic Pathology & Clinical Pathology Physician
  • Newark, OH
National Provider Identifier
1720303662
Registry record updated Jan 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
34.014928 Issued in OH
Practice address
1320 W Main St
Newark, OH 43055-1822
Phone
(220) 564-4218
Fax
(220) 564-4217
NPI assigned
Apr 4, 2010
Last updated
Jan 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 34.014928 OH Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 25MB09321500 NJ
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X 03343 KY

Addresses

Primary practice location

1320 W Main St
Newark, OH 43055-1822

Mailing address

1320 W Main St
Newark, OH 43055-1822
Phone (220) 564-4218

Other names 1

  • Nicole Bara Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nmiller23614@lickingmemorial.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20210415002827 OH Practitioner - Pathology 8820220650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1320 W Main St
Licking Memorial Pathology
Newark, OH 43055-1822
Phone (220) 564-4266

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03343KYMDClinical Pathology/Laboratory Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Licking Memorial Health Professionals CurrentSince Apr 14, 2021 Accepting new patients
Licking Memorial Professional Corporation CurrentSince Apr 14, 2021 Accepting new patients

Locations

120 McMillen Dr
Newark, OH 43055
Phone (220) 564-4806

1320 W Main St
Newark, OH 43055
Phone (740) 348-4151

Interoperability endpoints

  • Direct secure messaging: nmiller23614@lickingmemorial.medicity.net

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.

Hospital & facility affiliations 1

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": "1270339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1720303662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "220-564-4218",
            "fax_number": "220-564-4217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "220-564-4218",
            "fax_number": "220-564-4217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "NICOLE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-04",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OH",
            "license": "34.014928",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "25MB09321500",
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "KY",
            "license": "03343",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nmiller23614@lickingmemorial.medicity.net",
            "affiliation": "N",
            "address_1": "1320 W Main St",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430551822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BARA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newark, OH

Sources for this page

Verify at the official NPI Registry.