Active NPI
Robert Miller
- Medical Physician Assistant
- Grand Rapids, MI
National Provider Identifier
1902146582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 5601006600
- Practice address
- 3700 52ND St SE
Grand Rapids, MI 49512-9637 - Phone
- (616) 656-3700
- NPI assigned
- Feb 19, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601006600 | MI | Primary |
Addresses
Primary practice location
3700 52ND St SE
Grand Rapids, MI 49512-9637
Mailing address
3700 52ND St SE
Grand Rapids, MI 49512-9637
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601006600 | MI | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365465600000",
"number": "1902146582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 52ND ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495129637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3700 52ND ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495129637",
"telephone_number": "616-656-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "ROBERT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-19",
"last_updated": "2013-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MI",
"license": "5601006600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.