Individual provider Active NPI

Kathleen M Miller, MD

  • Psychiatry Physician
  • Logansport, IN
National Provider Identifier
1790883528
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01035452A Issued in IN
Practice address
1015 Michigan Ave
Logansport, IN 46947-1526
Phone
(574) 722-5151
Fax
(574) 739-1414
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 01035452A IN
Psychiatry Physician 2084P0800X 01035452A IN Primary

Addresses

Primary practice location

1015 Michigan Ave
Logansport, IN 46947-1526

Mailing address

1015 Michigan Ave
Logansport, IN 46947-1526
Phone (574) 722-5151

Other identifiers 1

IdentifierTypeStateIssuer
100352240MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20090604000281 IN Practitioner - Psychiatry 6103976659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Indiana University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Four County Comprehensive Mental Health Center IncGroup PAC ID 2163334277, 42 clinicians

Practice addresses (Care Compare)

1015 Michigan Ave
Logansport, IN 46947-1526
Phone (574) 722-5151

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Four County Comprehensive Mental Health Center, Inc CurrentSince Apr 14, 2009 Accepting new patients
Four County Comprehensive Mental Health Center Inc CurrentSince Apr 14, 2009 Accepting new patients

Locations

3118 S Lafountain St
Kokomo, IN 46902
Phone (765) 864-4160

1948 W Boulevard
Kokomo, IN 46902
Phone (765) 236-1290

421 12th St
Logansport, IN 46947
Phone (574) 722-7407

800 Fulton St
Logansport, IN 46947
Phone (574) 205-2600

1015 Michigan Ave
Logansport, IN 46947

2355 S Business 31
Peru, IN 46970

1000 N Broadway
Peru, IN 46970
Phone (765) 472-5335

401 E 8th St
Rochester, IN 46975
Phone (574) 223-8565

1060 S Main St
Tipton, IN 46072
Phone (765) 675-1111

2418 Curtis Dr
Winamac, IN 46996
Phone (219) 946-7710

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1790883528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471526",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471526",
            "telephone_number": "574-722-5151",
            "fax_number": "574-739-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KATHLEEN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "IN",
            "license": "01035452A",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01035452A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100352240",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logansport, IN

Sources for this page

Verify at the official NPI Registry.