Active NPI
Kellie Meyn
- Social Worker
- Plainfield, IL
National Provider Identifier
1104555184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150014780
- Practice address
- 5700 Caton Farm Rd
Plainfield, IL 60586-9905 - Phone
- (630) 945-6724
- NPI assigned
- Jun 6, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150014780 | IL | Primary |
Addresses
Primary practice location
5700 Caton Farm Rd
Plainfield, IL 60586-9905
Mailing address
2710 N 3764TH Rd
Sheridan, IL 60551-9755
Phone (630) 945-6724
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150014780 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind PC | Current | Accepting new patients |
Locations
416 Main St
Ste 601
Peoria, IL 61602
Phone (309) 945-3305
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": "1654473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654473600000",
"number": "1104555184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2710 N 3764TH RD",
"city": "SHERIDAN",
"state": "IL",
"postal_code": "605519755",
"telephone_number": "630-945-6724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5700 CATON FARM RD",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605869905",
"telephone_number": "630-945-6724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEYN",
"first_name": "KELLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-06",
"last_updated": "2022-06-06",
"certification_date": "2022-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150014780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plainfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.