Individual provider Active NPI

Kristin Miller, M.D.

  • Family Medicine Physician
  • Grants Pass, OR
National Provider Identifier
1740272285
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD21845 Issued in OR
Practice address
1701 NW Hawthorne Ave
Suite 201
Grants Pass, OR 97526-1257
Phone
(541) 471-3455
Fax
(541) 471-1439
NPI assigned
Aug 19, 2005
Last updated
Mar 23, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

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 MD21845 OR Primary

Addresses

Primary practice location

1701 NW Hawthorne Ave
Suite 201
Grants Pass, OR 97526-1257

Mailing address

1701 NW Hawthorne Ave
Suite 201
Grants Pass, OR 97526-1257
Phone (541) 471-3455

Other identifiers 1

IdentifierTypeStateIssuer
130289MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20040205001170 OR Practitioner - Family Practice 2466353255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 472-4777

25647 Redwood Hwy
Cave Junction, OR 97523-9332
Phone (541) 592-4111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD21845ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siskiyou Community Health Center, Inc Current Accepting new patients
Siskiyou Community Health Center, Inc. CurrentSince Sep 1, 1999 Accepting new patients
University Health Physicians Family Medicine Past Accepting new patients

Locations

1701 NW Hawthorne Ave
Grants Pass, OR 97526
Phone (541) 472-4777

1701 NW Hawthorne Ave
#201
Grants Pass, OR 97526

1701 NW Hawthorne Ave
Ste 201
Grants Pass, OR 97526
Phone (541) 471-3455

Interoperability endpoints

  • Direct secure messaging: kristin.miller@direct.siskiyou.nextgenshare.com

Organizations & group practices 3

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1740272285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "address_2": "SUITE 201",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261257",
            "telephone_number": "541-471-3455",
            "fax_number": "541-471-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "address_2": "SUITE 201",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261257",
            "telephone_number": "541-471-3455",
            "fax_number": "541-471-1439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2012-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD21845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130289",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

Verify at the official NPI Registry.