Individual provider Active NPI

Jason Edward Miller, MSW, LICSW

  • Clinical Social Worker
  • Arden Hills, MN
National Provider Identifier
1073144788
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
28758 Issued in MN
Practice address
3900 Northwoods Dr
Arden Hills, MN 55112-6966
Phone
(612) 371-5400
NPI assigned
Jan 31, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 28758 MN Primary

Addresses

Primary practice location

3900 Northwoods Dr
Arden Hills, MN 55112-6966

Mailing address

3900 Northwoods Dr
Arden Hills, MN 55112-6966

Other practice location 1

4027 County Road 25
Minneapolis, MN 55416-2629
Phone (612) 925-6033

Other practice location 2

6200 Shingle Creek Pkwy Ste 350
Brooklyn Center, MN 55430-2155
Phone (763) 503-8560

Other identifiers 1

IdentifierTypeStateIssuer
28758MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220210002055 MN Practitioner - Clinical Social Worker 1254724420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Group Health, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

Organizations & group practices 3

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": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1073144788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 NORTHWOODS DR",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551126966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 NORTHWOODS DR",
            "city": "ARDEN HILLS",
            "state": "MN",
            "postal_code": "551126966",
            "telephone_number": "612-371-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4027 County Road 25",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554162629",
            "country_code": "US",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6200 Shingle Creek Pkwy Ste 350",
            "address_purpose": "LOCATION",
            "city": "Brooklyn Center",
            "state": "MN",
            "postal_code": "554302155",
            "country_code": "US",
            "telephone_number": "763-503-8560",
            "fax_number": "763-503-8563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JASON",
        "middle_name": "EDWARD",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-31",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28758",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arden Hills, MN

Sources for this page

Verify at the official NPI Registry.