Active NPI
Jonathan M Miller, PHD LP
- Clinical Neuropsychologist
- Eagan, MN
National Provider Identifier
1992790117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- LP4000
- Practice address
- 2113 Cliff Dr
Eagan, MN 55122-3327 - Phone
- (651) 728-0922
- NPI assigned
- Sep 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | LP4000 | MN | Primary |
Addresses
Primary practice location
2113 Cliff Dr
Eagan, MN 55122-3327
Mailing address
2113 Cliff Dr
Eagan, MN 55122-3327
Phone (651) 728-0922
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 228524000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4000 | MN | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1992790117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2113 CLIFF DR",
"city": "EAGAN",
"state": "MN",
"postal_code": "551223327",
"telephone_number": "651-728-0922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2113 CLIFF DR",
"city": "EAGAN",
"state": "MN",
"postal_code": "551223327",
"telephone_number": "651-728-0922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "JONATHAN",
"middle_name": "M",
"credential": "PHD LP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-14",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MN",
"license": "LP4000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "228524000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.