Individual provider Active NPI

Brenda Denise Miller

  • Case Manager/Care Coordinator
  • Fargo, ND
National Provider Identifier
1861190845
Registry record updated Feb 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
License
00000 Issued in ND
Practice address
111 9TH St S
Fargo, ND 58103-1831
Phone
(701) 361-9922
Fax
(701) 829-7170
NPI assigned
Feb 20, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X 00000 ND Primary

Addresses

Primary practice location

111 9TH St S
Fargo, ND 58103-1831

Mailing address

21 9TH St S
Fargo, ND 58103-1830
Phone (701) 361-9922

Other practice location 1

921 2nd Ave S
Fargo, ND 58103-1705
Phone (701) 361-9922

Other identifiers 1

IdentifierTypeStateIssuer
171M00000XMedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
00000NDMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Lighthouse Church of Fargo Case Manager/Care Coordinator CurrentSince Feb 26, 2023 Accepting new patients
Beacon of Light House CurrentSince Mar 12, 2023 Accepting new patients
Light House Recovery Services PastSince Mar 12, 2023 Accepting new patients

Locations

21 9th St S
Fargo, ND 58103
Phone (701) 893-8498

111 9th St S
Fargo, ND 58103
Phone (701) 212-8626

Organizations & group practices 3

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": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1861190845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 9TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031830",
            "telephone_number": "701-361-9922",
            "fax_number": "701-829-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 9TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031831",
            "telephone_number": "701-361-9922",
            "fax_number": "701-829-7170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 2nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581031705",
            "country_code": "US",
            "telephone_number": "701-361-9922",
            "fax_number": "701-829-7170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BRENDA",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "ND",
            "license": "00000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171M00000X",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.