Individual provider Active NPI

Bernadette Mullins-Miller, LCSW

  • Clinical Social Worker
  • Wauwatosa, WI
National Provider Identifier
1083839609
Registry record updated Oct 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
133 Issued in WI
Practice address
2600 N Mayfair Rd Ste 305
Wauwatosa, WI 53226-1303
Phone
(414) 378-0999
Fax
(414) 536-8605
NPI assigned
Apr 17, 2007
Last updated
Oct 24, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2014

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 133 WI Primary

Addresses

Primary practice location

2600 N Mayfair Rd Ste 305
Wauwatosa, WI 53226-1303

Mailing address

2600 N Mayfair Rd Ste 305
Wauwatosa, WI 53226-1303
Phone (414) 378-0999

Other identifiers 4

IdentifierTypeStateIssuer
K300159069OtherWIMEDICARE PTAN PART B
39223700MedicaidWI
SUFFIX BOtherWIHUMANA ID NUMBER
391786254014OtherWIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20080820000394 WI Practitioner - Clinical Social Worker 5395810725 Practice locations: Wauwatosa, WI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

933 N Mayfair Rd
Suite 101
Wauwatosa, WI 53226-3432
Phone (414) 378-0999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
133WIMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Bernadette Mullins Miller LLC PastSince Mar 1, 2014 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1083839609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD STE 305",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261303",
            "telephone_number": "414-378-0999",
            "fax_number": "414-536-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD STE 305",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261303",
            "telephone_number": "414-378-0999",
            "fax_number": "414-536-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS-MILLER",
        "first_name": "BERNADETTE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN PART B",
            "identifier": "K300159069",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39223700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA ID NUMBER",
            "identifier": "SUFFIX B",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "391786254014",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.