Jill C Miller, M.D.
Individual provider Active NPI Family Medicine Physician · Weed, CA
NPI 1992796064 · NPPES record last updated Jul 18, 2019
Key facts
- NPI
- 1992796064
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G86655 (CA)
- Practice address
- 16337 Everhart Dr
Weed, CA 96094 - Phone
- (530) 938-2297
- Fax
- (530) 938-0494
- NPI assigned
- Oct 28, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150508001123 | CA | Order and Referring Only - Family Practice |
0042290587 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86655 | CA | MD | Clinical Social Worker |
| G86655 | CA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G86655 | CA | Yes |
Addresses
Primary practice location
16337 Everhart Dr
Weed, CA 96094
Mailing address
16337 Everhart Dr
Weed, CA 96094-9400
Phone (530) 938-2297
Other practice location 1
912 Pine St
Mount Shasta, CA 96067-2143
Phone (530) 926-7131
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G866550 | Medicaid | CA |
Other providers in Weed, CA
- Lake Shastina Medical Clinic Inc
- Jenna Lynn Henson Marshall
- Theresa Anne Maurer
- Kristin Mercier
- Meridian Health Services Corporation
- Mountain Valleys Health Centers
- Zachary James Myers
- Jeffrey Alexander Ott
- Jaya Ottens
- Laurie Ottens
All providers in Weed, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2019. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.