Individual provider Active NPI

Brendan J Miller, FNPC

  • Nurse Practitioner
  • Bangor, ME
National Provider Identifier
1851742472
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CNP171015 Issued in ME
Practice address
1012 Union St
Bangor, ME 04401-3060
Phone
(207) 404-8200
Fax
(207) 947-0435
NPI assigned
Jun 24, 2016
Last updated
May 5, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNP171015 ME Primary

Addresses

Primary practice location

1012 Union St
Bangor, ME 04401-3060

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 404-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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

Enrollment IDStateProvider typePAC IDDetails
I20170515000521 ME Practitioner - Nurse Practitioner 6305133661 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

1012 Union St
Bangor, ME 04401-3058

1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181

181 Corporate Dr
Bangor, ME 04401-4314
Phone (207) 992-2636

30 Summer St
Bangor, ME 04401-6467
Phone (207) 404-8383

6 Telcom Dr
Bangor, ME 04401-3072
Phone (207) 941-2850

992 Union St
Bangor, ME 04401-3057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP171015MEMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Jun 1, 2017 Accepting new patients
Penobscot Community Health Center CurrentSince Jun 1, 2017 Accepting new patients
Penobscot Community Health Center Current Accepting new patients
Penobscot Community Health Center Past Accepting new patients

Locations

1012 Union St
Bangor, ME 04401
Phone (207) 404-8200

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

1012 Union St
Ste 3
Bangor, ME 04401
Phone (207) 404-8040

1068 Union St
Bangor, ME 04401
Phone (207) 404-8181

6 Telcom Dr
Fl 2
Bangor, ME 04401
Phone (207) 947-0147

29 Schoodic Dr
Belfast, ME 04915
Phone (207) 218-6001

53 Schoodic Dr
Belfast, ME 04915
Phone (207) 338-6900

735 Wilson St
Brewer, ME 04412
Phone (207) 989-1567

242 Brunswick St
Old Town, ME 04468
Phone (207) 827-6128

Organizations & group practices 5

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": "1466726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1851742472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 UNION ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013060",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BRENDAN",
        "middle_name": "J",
        "credential": "FNPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-24",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ME",
            "license": "CNP171015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.