Physician Compare National (NPI:1427317825)

HEALTHCARE PROVIDER: GREGORY DEVON MILLER D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1427317825
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9335366186
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160629000056
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MILLER
	Individual professional last name
Provider First Name	GREGORY
	Individual professional first name
Provider Middle Name	DEVON
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5422 1ST COAST HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 116
	Group Practice or individual's line 2 address
City	FERNANDINA BEACH
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	320345423
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100088
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAPTIST MEDICAL CENTER JACKSONVILLE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100140
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAPTIST MEDICAL CENTER NASSAU
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y