Individual provider Active NPI

David Ray Miller, DDS

  • Dentist
  • Mount Carmel, IL
National Provider Identifier
1972649390
Registry record updated Nov 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019018543 Issued in IL
Practice address
325 East 13TH Street
Mount Carmel, IL 62863
Phone
(618) 263-6555
Fax
(618) 262-7423
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019018543 IL Primary

Addresses

Primary practice location

325 East 13TH Street
Mount Carmel, IL 62863

Mailing address

325 East 13TH Street
Mount Carmel, IL 62863
Phone (618) 263-6555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617000011 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8426036062

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019018543ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
David R Miller DDS PC PastSince Sep 13, 2020 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wabash General Hospital Primary CareMount Carmel, IL, CCN 148568 Rural health clinic Contracted Managing Employee
Corporate Director
Oct 1, 2019
Sep 28, 2020
Wabash General Hospital Primary Care College Drive LocationMount Carmel, IL, CCN 148579 Rural health clinic Corporate Director Sep 28, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289865600000",
    "number": "1972649390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 EAST 13TH STREET",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "62863",
            "telephone_number": "618-263-6555",
            "fax_number": "618-262-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 EAST 13TH STREET",
            "city": "MOUNT CARMEL",
            "state": "IL",
            "postal_code": "62863",
            "telephone_number": "618-263-6555",
            "fax_number": "618-262-7423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "DAVID",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2010-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019018543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Carmel, IL

Sources for this page

Verify at the official NPI Registry.