Russell Miller MD Family Practice PC
Organization Active NPI Family Medicine Physician · Patton, PA
NPI 1932390895 · NPPES record last updated Aug 6, 2007
Key facts
- NPI
- 1932390895
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- RUSSELL MILLER MD FAMILY PRACTICE PC
- Practice address
- 121 Beech Avenue
Patton, PA 16668-1017 - Phone
- (814) 674-5225
- Fax
- (814) 674-2338
- NPI assigned
- Aug 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Russell Paul Miller, MD
- Title
- President
- Phone
- (814) 674-5225
Practitioners 2
-
Russell Paul Miller, M.D.
-
Megan Melissa Roberts, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D0935566 | Russell Miller MD Family Practice PC | Provider-performed microscopy | Nov 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050125000698 | PA | Part B Supplier - Clinic/Group Practice | 5193775435 |
Receives reassigned benefits from 2 practitioners Practice locations: Patton, PA |
National Provider Directory
Locations
121 Beech Ave
Patton, PA 16668
Phone (814) 674-5225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
121 Beech Avenue
Patton, PA 16668-1017
Mailing address
121 Beech Avenue
Patton, PA 16668-1017
Phone (814) 674-5225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0016115020008 | Medicaid | PA |
Other providers in Patton, PA
- Patton Area Ambulance Assn.
- Patton Rehabilitation Associates Inc
- Maura Risbon
- Megan Melissa Roberts
- RP-PRN Inc
- Rxvip PA LLC
- Rxvip PA LLC
- Lindsy Sammarco
- Jennifer Stich
- Renae A Stoskey
All providers in Patton, PA · Family Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.