Kevin L Miller, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

L1393 Issued in TX

Practice address

700 San Gabriel Village Blvd
Ste 105
Georgetown, TX 78626-5594

Phone

(512) 819-9910

Fax

(512) 819-9970

NPI assigned

Mar 31, 2006

Last updated

Aug 23, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Dermatology

Education

Texas Tech University Health Science Center School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oliver Street 5.01(a) IncGroup PAC ID 0042464125, 169 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Oliver Street 5.01(a) Inc.

  dba U.S. Dermatology Partners

  • Dermatology Physician
  • Dallas, TX
  • NPI 1457695413
  Medicare reassignment Care Compare group NPD
• Kevin L Miller MD, PA

  dba Georgetown Dermatology and Skin Cancer Center

  • Dermatology Physician
  • Georgetown, TX
  • NPI 1548451610
  Authorized official Same address or phone
• Devenir Aesthetics, PA

  • Plastic Surgery Physician
  • Austin, TX
  • NPI 1477584845
  NPD (past)

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1821059395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SAN GABRIEL VILLAGE BLVD",
            "address_2": "STE 105",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786265594",
            "telephone_number": "512-819-9910",
            "fax_number": "512-819-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SAN GABRIEL VILLAGE BLVD",
            "address_2": "STE 105",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786265594",
            "telephone_number": "512-819-9910",
            "fax_number": "512-819-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KEVIN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "L1393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID",
            "identifier": "7524367",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0034KL",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Miller
• Brian Terry Miller, D.O.
• Erin Loretta Miller, APRN, CPNP-PC
• Jonathan G Miller
• Katherine Miller
• Mary Miller, LVN
• Michael Miller, M.D.
• Susan Aileen Miller, N.P.
• Deidra Milling, M.ED. DIAGNOSTICIAN
• Carol A Minchew, COTA

• Dermatology Physician in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; 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.