Individual provider Active NPI

Bernard Victor Miller III, M.D.

  • General Practice Physician
  • Saint Louis, MO
National Provider Identifier
1851576029
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
2002031639 Issued in MO
Practice address
8710 Manchester Rd
Saint Louis, MO 63144-2724
Phone
(314) 961-3570
NPI assigned
Jan 7, 2008
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 2002031639 MO Primary

Addresses

Primary practice location

8710 Manchester Rd
Saint Louis, MO 63144-2724

Mailing address

8710 Manchester Rd
Saint Louis, MO 63144-2724
Phone (314) 961-3570

Other practice location 1

660 S Euclid Ave
Campus Box 8031
Saint Louis, MO 63110-1010
Phone (314) 362-8673

Other practice location 2

660 S Euclid Ave
Campus Box 8031
Saint Louis, MO 63110-1010
Phone (314) 362-8673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20171025002176 MO Practitioner - Internal Medicine 3971885500 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2002031639MOMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Miller Diversified Health Partnerships LLC Current Accepting new patients
Miller Diversified Clinical LLC Current Accepting new patients
Vpa PC General Practice CurrentSince Nov 1, 2017 Accepting new patients
Vpa PC General Practice CurrentSince Nov 1, 2017 Accepting new patients

Locations

500 Kirts Blvd
Ste 100
Troy, MI 48084
Phone (214) 824-6000

8706 Manchester Rd
Ste 106
Saint Louis, MO 63144
Phone (314) 961-3570

8710 Manchester Rd
Saint Louis, MO 63144
Phone (314) 961-3570

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1851576029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8710 MANCHESTER RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631442724",
            "telephone_number": "314-961-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8710 MANCHESTER RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631442724",
            "telephone_number": "314-961-3570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "660 S Euclid Ave",
            "address_2": "Campus Box 8031",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101010",
            "country_code": "US",
            "telephone_number": "314-362-8673",
            "fax_number": "314-362-8230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "660 S Euclid Ave",
            "address_2": "Campus Box 8031",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101010",
            "country_code": "US",
            "telephone_number": "314-362-8673",
            "fax_number": "314-362-8230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BERNARD",
        "middle_name": "VICTOR",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "2002031639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.