Active NPI
Melissa Buckley
- Social Worker
- Dixon, IL
National Provider Identifier
1093149452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 149.024911
- Practice address
- 325 Il Route 2
Dixon, IL 61021-9118 - Phone
- (815) 284-6611
- NPI assigned
- Aug 21, 2013
- Reactivated
- Dec 20, 2022
- Last updated
- Jun 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 149.024911 | IL | |
| Social Worker | 104100000X | 149.024911 | IL | Primary |
Addresses
Primary practice location
325 Il Route 2
Dixon, IL 61021-9118
Mailing address
311 W Park St
Morrison, IL 61270-2319
Phone (815) 213-4389
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230209002735 | IL | Practitioner - Clinical Social Worker | 6507238011 |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2261 Market St
San Francisco, CA 94114-1612
311 W Park St
Morrison, IL 61270-2319
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.024911 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sinnissippi Centers, Inc. | Past | 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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Rochelle, IL
- NPI 1407143837
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685923200000",
"number": "1093149452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 W PARK ST",
"city": "MORRISON",
"state": "IL",
"postal_code": "612702319",
"telephone_number": "815-213-4389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 IL ROUTE 2",
"city": "DIXON",
"state": "IL",
"postal_code": "610219118",
"telephone_number": "815-284-6611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-21",
"last_updated": "2023-06-05",
"certification_date": "2023-06-04",
"deactivation_date": "2022-11-09",
"reactivation_date": "2022-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": "149.024911",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "149.024911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dixon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.