Amanda Miller, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601005922 Issued in MI

Practice address

655 Kenmoor Ave SE
Suite 200
Grand Rapids, MI 49546-8622

Phone

(616) 949-5600

Fax

(616) 949-6571

NPI assigned

May 4, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dawm, PLCGroup PAC ID 8224032594, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Dawm, PLC

  • Dermatology Physician
  • Grand Rapids, MI
  • NPI 1932132446
  Medicare reassignment Care Compare group
• Internal Medicine and Pediatrics of West Michigan

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1104170661
  NPD (past)
• Dermatology and Mohs Surgery Institute, LTD.

  • Specialist
  • Bloomington, IL
  • NPI 1770828626
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533686400000",
    "number": "1811289259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 KENMOOR AVE SE",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468622",
            "telephone_number": "616-949-5600",
            "fax_number": "616-949-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 KENMOOR AVE SE",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468622",
            "telephone_number": "616-949-5600",
            "fax_number": "616-949-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "AMANDA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-04",
        "last_updated": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005922",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5601005922",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5601005922",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Creese Miller, NP
• Adam David Miller, M.D.
• Alexis Miller, MA, LPC
• Alexus Miller
• Allison Riekse Miller, PA-C
• Amanda Jane Miller, LLP
• Andrew Miller, MD
• Angela Miller
• Arean Miller
• Ashley Nicole Miller

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.