Individual provider Active NPI

Brent John Miller, NP

  • Family Nurse Practitioner
  • Fremont, MI
National Provider Identifier
1962414235
Registry record updated Aug 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704186025 Issued in MI
Practice address
212 S Sullivan
Fremont, MI 49412
Phone
(231) 924-1300
NPI assigned
Aug 13, 2006
Last updated
Aug 3, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704186025 MI Primary

Addresses

Primary practice location

212 S Sullivan
Fremont, MI 49412

Mailing address

2537 Momentum PL
Chicago, IL 60689-0001
Phone (616) 975-1845

Other identifiers 1

IdentifierTypeStateIssuer
500027220OtherMIRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20100622000422 MI Practitioner - Nurse Practitioner 4880725746 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians

Practice addresses (Care Compare)

212 S Sullivan Ave
Fremont, MI 49412-1548
Phone (866) 270-4203

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.48 of 100Reported as group
Quality
89.26
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704186025MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Visionary Medical Services PC CurrentSince Apr 19, 2024 Accepting new patients
Ecs Western Michigan PC CurrentSince Aug 1, 2018 Accepting new patients

Locations

605 Oak St
Big Rapids, MI 49307
Phone (231) 592-1079

212 S Sullivan Ave
Fremont, MI 49412
Phone (231) 924-1212

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

1840 Wealthy St SE
Grand Rapids, MI 49506
Phone (616) 391-1730

615 S Bower St
Greenville, MI 48838
Phone (616) 754-4341

Organizations & group practices 2

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 3

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249257600000",
    "number": "1962414235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2537 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606890001",
            "telephone_number": "616-975-1845",
            "fax_number": "616-975-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S SULLIVAN",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "49412",
            "telephone_number": "231-924-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "BRENT",
        "middle_name": "JOHN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2009-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704186025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "500027220",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, MI

Sources for this page

Verify at the official NPI Registry.