Individual provider Active NPI

Kevin Jeffery Miretzky, MSW

  • Clinical Social Worker
  • Northfield, IL
National Provider Identifier
1093437964
Registry record updated Sep 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
405 Central Ave
Northfield, IL 60093-3006
Phone
(847) 441-5600
NPI assigned
Sep 16, 2022
Last updated
Sep 16, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2022

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 NU Primary

Addresses

Primary practice location

405 Central Ave
Northfield, IL 60093-3006

Mailing address

405 Central Ave
Northfield, IL 60093-3006
Phone (847) 441-5600

Other names 1

  • Tzvi Yaakov Miretzky Other name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240925000153 IL Practitioner - Clinical Social Worker 2961943378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Josselyn Center NFPGroup PAC ID 0840289740, 86 clinicians

Practice addresses (Care Compare)

1135 Skokie Blvd
Northbrook, IL 60062-4118
Phone (847) 441-5600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Josselyn Center NFP Current Accepting new patients
The Josselyn Center CurrentSince Sep 17, 2024 Accepting new patients
The Josselyn Center NFP CurrentSince Sep 17, 2024 Accepting new patients
Focused and Balance Life Therapy PLLC CurrentSince Oct 1, 2024 Accepting new patients
The Josselyn Center NFP Past Accepting new patients

Locations

1135 Skokie Blvd
Northbrook, IL 60062
Phone (224) 290-1327

405 Central Ave
Northfield, IL 60093
Phone (847) 441-5603

Organizations & group practices 5

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": "1663286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1093437964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 CENTRAL AVE",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933006",
            "telephone_number": "847-441-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 CENTRAL AVE",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600933006",
            "telephone_number": "847-441-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRETZKY",
        "first_name": "KEVIN",
        "middle_name": "JEFFERY",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-16",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TZVI",
            "last_name": "MIRETZKY",
            "middle_name": "YAAKOV",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Northfield, IL

Sources for this page

Verify at the official NPI Registry.