Miles Robert Congress, MD
Emergency Medicine · San Jose
- Medicare standing
- Clear
- Enrolled, allowed to bill and order, not excluded
- Plans that list them
- 7
- 3 carriers
- Office
- 1
Offices
1 location
Plans that list them
7 plans · 3 carriers
A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Congress’s office at (408) 559-2011 to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.
7 of 7 plans
| Astiva Health C-SNP WOW - NorCal (HMO C-SNP) | Astiva Health | Listed | Sep 27, 2026 |
| Astiva Health Premier Plan - NorCal (HMO) | Astiva Health | Listed | Sep 27, 2026 |
| Astiva Health Savings Plan - NorCal (HMO) | Astiva Health | Listed | Sep 27, 2026 |
| Blue Shield Inspire (HMO) | Blue Shield of California | Listed | Aug 26, 2026 |
| Imperial Courage Plan (HMO) | Imperial Health Plan of California, Inc. | Listed | Sep 1, 2026 |
| Imperial Dynamic Plan (HMO) | Imperial Health Plan of California, Inc. | Listed | Sep 1, 2026 |
| Imperial Senior Value (HMO C-SNP) | Imperial Health Plan of California, Inc. | Listed | Sep 1, 2026 |
California Medical Board record
Licence G36294 · Current
Licensed to practise in California · since 1978 · expires 2028-03-31 · Umdnj Robert Wood Johnson Medical School.
No disciplinary actions, convictions, malpractice judgments or citations in this record.
Original Medicare doctor bills
$6,900
Medicare paid this office $6,900 for 56 people.
This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.
| Emergency department visit with moderate level of medical decision making | 32 | $3,239 | $88 |
| Emergency department visit with high level of medical decision making | 19 | $2,676 | $134 |
Who their Medicare patients are
56 Original Medicare patients in 2024. Average age 74 · Women 59% · Health risk score 1.20. At or below the middle of the specialty; the typical emergency medicine clinician is at 2.01.
Conditions among them: High blood pressure 61% · Coronary heart disease 21% · Atrial fibrillation 21% · Depression 21%.
The office billed $72,167, Medicare allowed $8,886 and paid $6,900; for 81 services of 10 kinds.
Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.
Year by year
| 2024 | 56 | 81 | 74 | 1.20 | $72,167 | $6,900 |
| 2023 | 48 | 68 | 75 | 0.84 | $66,837 | $5,870 |
| 2022 | 45 | 65 | 74 | 1.00 | $51,843 | $5,012 |
| 2021 | 31 | 36 | 74 | 1.30 | $25,494 | $3,120 |
| 2020 | 164 | 260 | 73 | 1.40 | $157,500 | $21,384 |
| 2019 | 147 | 213 | 71 | 1.35 | $121,266 | $16,582 |
| 2018 | 149 | 248 | 73 | 1.18 | $101,855 | $19,542 |
| 2017 | 144 | 238 | 72 | 1.40 | $85,338 | $23,307 |
| 2016 | 139 | 206 | 70 | 1.32 | $74,185 | $14,494 |
| 2015 | 174 | 277 | 72 | 1.25 | $104,172 | $20,536 |
| 2014 | 240 | 401 | 74 | 1.42 | $141,255 | $30,379 |
| 2013 | 538 | 861 | 74 | 1.65 | $286,453 | $68,386 |
Original Medicare only. A service billed for fewer than 11 people in a year is hidden, so the lines can add up to less than the year's total.
See the services billed each year
2023: 1 service
| Emergency department visit with moderate level of medical decision making | 35 | $3,358 | $93 |
2022: 2 services
| Emergency department visit with moderate level of medical decision making | 18 | $1,722 | $96 |
| Emergency department visit with low level of medical decision making | 16 | $903 | $56 |
2021: 1 service
| Emergency department visit with low level of medical decision making | 13 | $796 | $61 |
2020: 5 services
| Emergency department visit with high level of medical decision making | 77 | $11,171 | $143 |
| Emergency department visit with moderate level of medical decision making | 48 | $4,252 | $85 |
| Critical care, first 30-74 minutes | 12 | $2,257 | $188 |
| Emergency department visit with low level of medical decision making | 30 | $1,630 | $51 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 56 | $409 | $6 |
2019: 4 services
| Emergency department visit with high level of medical decision making | 55 | $7,628 | $134 |
| Emergency department visit with moderate level of medical decision making | 40 | $3,414 | $85 |
| Emergency department visit with low level of medical decision making | 47 | $2,201 | $47 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 41 | $279 | $7 |
2018: 4 services
| Emergency department visit with high level of medical decision making | 66 | $10,259 | $147 |
| Emergency department visit with moderate level of medical decision making | 37 | $3,748 | $94 |
| Emergency department visit with low level of medical decision making | 40 | $2,008 | $49 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 56 | $507 | $8 |
2017: 4 services
| Emergency department visit with high level of medical decision making | 54 | $10,955 | $186 |
| Emergency department visit with moderate level of medical decision making | 41 | $5,700 | $130 |
| Emergency department visit with low level of medical decision making | 48 | $3,076 | $59 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 45 | $491 | $10 |
2016: 4 services
| Emergency department visit with high level of medical decision making | 50 | $7,066 | $131 |
| Emergency department visit with moderate level of medical decision making | 37 | $3,107 | $84 |
| Emergency department visit with low level of medical decision making | 50 | $2,152 | $43 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 40 | $311 | $7 |
2015: 4 services
| Emergency department visit with high level of medical decision making | 84 | $11,194 | $130 |
| Emergency department visit with moderate level of medical decision making | 41 | $3,429 | $82 |
| Emergency department visit with low level of medical decision making | 53 | $2,237 | $41 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 53 | $388 | $7 |
2014: 5 services
| Emergency department visit with high level of medical decision making | 123 | $16,869 | $134 |
| Emergency department visit with moderate level of medical decision making | 53 | $4,616 | $84 |
| Critical care, first 30-74 minutes | 13 | $2,400 | $185 |
| Emergency department visit with low level of medical decision making | 55 | $2,377 | $43 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 107 | $844 | $7 |
2013: 5 services
| Emergency department visit with high level of medical decision making | 225 | $31,988 | $140 |
| Emergency department visit with moderate level of medical decision making | 147 | $15,375 | $95 |
| Critical care, first 30-74 minutes | 49 | $9,223 | $188 |
| Emergency department visit with low level of medical decision making | 123 | $6,154 | $49 |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 217 | $1,692 | $7 |
Medicaid work
$1,413 in 2020
Medicaid paid $1,413 for 33 billed services this clinician did in 2020, up to 20 people in a month for one service.
Medicaid and CHIP claims where this clinician did the service, fee-for-service and managed care together. Any month with fewer than 11 patients is hidden, so small Medicaid practices undercount.
| EMERGENCY DEPT VISIT LOW MDM | 33 | $1,413 |
| 2020 | 33 | 1 | 20 | $1,413 |
| 2019 | 62 | 1 | 19 | $2,688 |
| 2018 | 88 | 1 | 21 | $3,829 |
See the largest Medicaid services in earlier years
2019
| EMERGENCY DEPT VISIT LOW MDM | 62 | $2,688 |
2018
| EMERGENCY DEPT VISIT LOW MDM | 88 | $3,829 |
Professional record
- NPI
- 1144268418
- Licence
- CA G36294California G36294: Current · expires 2028-03-31
More record details
- Sole proprietor
- No
- Taxonomy
- Federal specialty code 207P00000X (207P00000X)
- Mailing address
- 2100 Powell Street, Ste 920, Emeryville, CA, 94608
- NPI first listed
- 2006-06-02
- NPI last updated
- 2026-07-13
This is when the NPI record was last certified, not a medical board exam.