Individual provider Active NPI

Kristin B Miller, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1902068042
Registry record updated Jun 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2272 Issued in WI
Practice address
2350 N Lake Dr
Suite 206
Milwaukee, WI 53211-4528
Phone
(414) 298-7280
Fax
(414) 298-7281
NPI assigned
Jun 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2272 WI Primary

Addresses

Primary practice location

2350 N Lake Dr
Suite 206
Milwaukee, WI 53211-4528

Mailing address

2350 N Lake Dr
Suite 206
Milwaukee, WI 53211-4528
Phone (414) 298-7280

Other identifiers 1

IdentifierTypeStateIssuer
420040000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20080729000284 WI Practitioner - Physician Assistant 6901970771 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13133 N Port Washington Rd
Suite 116
Mequon, WI 53097-2422
Phone (262) 243-3700

2323 N Lake Dr
Milwaukee, WI 53211-4508

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2272WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince May 1, 2009 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince May 1, 2009 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc Past Accepting new patients

Locations

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

7080 N Port Washington Rd
Glendale, WI 53217
Phone (414) 228-4940

13133 N Port Washington Rd
Ste 116
Mequon, WI 53097
Phone (262) 243-3700

3056 S Kinnickinnic Ave
Ste 302
Milwaukee, WI 53207
Phone (414) 294-0971

2350 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1556

2350 N Lake Dr
Ste 206
Milwaukee, WI 53211
Phone (414) 271-1633

830 E Green Bay Ave
Saukville, WI 53080
Phone (262) 284-7117

1414 N Taylor Dr
Ste 210
Sheboygan, WI 53081
Phone (262) 243-2500

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466121600000",
    "number": "1902068042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 N LAKE DR",
            "address_2": "SUITE 206",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114528",
            "telephone_number": "414-298-7280",
            "fax_number": "414-298-7281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 N LAKE DR",
            "address_2": "SUITE 206",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532114528",
            "telephone_number": "414-298-7280",
            "fax_number": "414-298-7281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KRISTIN",
        "middle_name": "B",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-30",
        "last_updated": "2016-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420040000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.