Active NPI
Jerry Paul Miller III
- Interventional Pain Medicine Physician
- Columbia, MO
National Provider Identifier
1811255201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- License
- 304573
- Practice address
- 800 Hospital Dr
Columbia, MO 65201-5275 - Phone
- (573) 814-6000
- NPI assigned
- Apr 24, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician | 208VP0014X | 304573 | LA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
800 Hospital Dr
Columbia, MO 65201-5275
Mailing address
4701 Cedar Coals CT # a
Columbia, MO 65203-9072
Phone (985) 515-4779
Other practice location 1
1516 Aztec Ave
Apt#209
Metairie, LA 70005-1266
Phone (985) 515-4779
Other names 1
- Jay Paul Miller
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160415000221 | LA | Order and Referring Only - Physical Medicine and Rehabilitation | 4688972292 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 304573 | LA | MD | Interventional Pain Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650240000000",
"number": "1811255201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4701 CEDAR COALS CT # A",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652039072",
"telephone_number": "985-515-4779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 HOSPITAL DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652015275",
"telephone_number": "573-814-6000"
}
],
"practiceLocations": [
{
"address_1": "1516 Aztec Ave",
"address_2": "Apt#209",
"address_purpose": "LOCATION",
"city": "Metairie",
"state": "LA",
"postal_code": "700051266",
"country_code": "US",
"telephone_number": "985-515-4779",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MILLER",
"first_name": "JERRY",
"middle_name": "PAUL",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-24",
"last_updated": "2022-04-18",
"certification_date": "2022-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "LA",
"license": "304573",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JAY",
"last_name": "MILLER",
"middle_name": "PAUL",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.