NPIMap

Individual provider Active NPI

Blake Miller, DO

  • Orthopaedic Surgery Physician
  • Rockford, MI
National Provider Identifier
1952564130
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
5101017873 Issued in MI
Practice address
120 Marcell Dr NE Ste C
Rockford, MI 49341-1362
Phone
(616) 884-0003
NPI assigned
Jul 8, 2008
Last updated
Mar 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 5101017873 MI Primary

Addresses

Primary practice location

120 Marcell Dr NE Ste C
Rockford, MI 49341-1362

Mailing address

120 Marcell Dr NE Ste C
Rockford, MI 49341-1362
Phone (616) 884-0003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140819000750 MI Practitioner - Orthopedic Surgery 7618194465 Reassigns benefits to 1 organization
I20241101002011 IL Practitioner - Orthopedic Surgery 7618194465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acute Care Surgery of South Dakota PCGroup PAC ID 5698195030, 67 clinicians

Practice addresses (Care Compare)

405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 227-7500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group Orthopaedic Surgery CurrentSince Oct 12, 2020 Accepting new patients
Advantage Health/Saint Mary's Medical Group Current Accepting new patients
Acute Care Surgery of South Dakota PC Orthopaedic Surgery CurrentSince Oct 15, 2024 Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Oct 12, 2020 Accepting new patients

Locations

405 W Jackson St
Carbondale, IL 62901

19 E Shawnee Dr
Murphysboro, IL 62966
Phone (618) 684-2172

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

245 Cherry St SE
Ste 200
Grand Rapids, MI 49503
Phone (616) 685-3330

260 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 459-1267

Interoperability endpoints

  • Direct secure messaging: bmiller80098@sih.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743033600000",
    "number": "1952564130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MARCELL DR NE STE C",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411362",
            "telephone_number": "616-884-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MARCELL DR NE STE C",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411362",
            "telephone_number": "616-884-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BLAKE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-08",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "5101017873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

Verify at the official NPI Registry.