Active NPI
Russell J Miller, PA C
- Medical Physician Assistant
- Coal Township, PA
National Provider Identifier
1780646158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- MA 001072 L
- Practice address
- 1468 Trevorton Rd
Coal Township, PA 17866-7725 - Phone
- (570) 648-9769
- Fax
- (717) 692-2381
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA 001072 L | PA | Primary |
Addresses
Primary practice location
1468 Trevorton Rd
Coal Township, PA 17866-7725
Mailing address
1468 Trevorton Rd
Coal Township, PA 17866-7725
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA 001072 L | Other | PA | STATE LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 001072 L | PA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467244800000",
"number": "1780646158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1468 TREVORTON RD",
"city": "COAL TOWNSHIP",
"state": "PA",
"postal_code": "178667725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1468 TREVORTON RD",
"city": "COAL TOWNSHIP",
"state": "PA",
"postal_code": "178667725",
"telephone_number": "570-648-9769",
"fax_number": "717-692-2381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "RUSSELL",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2016-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA 001072 L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE #",
"identifier": "MA 001072 L",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coal Township, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.