Individual provider Active NPI

Brett Miller, DDS

  • Dentist
  • Yakima, WA
National Provider Identifier
1831133974
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00010390 Issued in WA
Practice address
12 S 8TH St
Yakima, WA 98901-3020
Phone
(509) 454-4143
Fax
(509) 454-3651
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE00010390 WA Primary

Addresses

Primary practice location

12 S 8TH St
Yakima, WA 98901-3020

Mailing address

PO Box 2605
Yakima, WA 98907-2605
Phone (509) 454-4143

Other identifiers 1

IdentifierTypeStateIssuer
5049192MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160520000460 WA Order and Referring Only - DentistPractitioner - Dentist 5698064236

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE00010390WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Neighborhood Health Services Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Neighborhood Health Terrace HeightsYakima, WA, CCN 941084 Federally qualified health center Corporate Officer Oct 1, 2020
Yakima Neighborhood Health ServicesYakima, WA, CCN 501032 Federally qualified health center Corporate Officer Oct 1, 2020
Yakima Neighborhood Health ServicesYakima, WA, CCN 501047 Federally qualified health center Corporate Officer Oct 1, 2021

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309996800000",
    "number": "1831133974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2605",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989072605",
            "telephone_number": "509-454-4143",
            "fax_number": "509-454-3651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 S 8TH ST",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989013020",
            "telephone_number": "509-454-4143",
            "fax_number": "509-454-3651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BRETT",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2011-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00010390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5049192",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.