Individual provider Active NPI

Todd S Miller

  • Professional Counselor
  • Waukegan, IL
National Provider Identifier
1114291911
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
178004336 Issued in IL
Practice address
3010 Grand Ave
Waukegan, IL 60085-2321
Phone
(847) 377-8200
NPI assigned
Feb 27, 2012
Last updated
Feb 27, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 178004336 IL Primary

Addresses

Primary practice location

3010 Grand Ave
Waukegan, IL 60085-2321

Mailing address

3010 Grand Ave
Waukegan, IL 60085-2321

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
I20240229001055 IL Practitioner - Mental Health Counselor 6305281361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of LakeGroup PAC ID 7214838861, 42 clinicians

Practice addresses (Care Compare)

224 W Clarendon Dr
Round Lake Beach, IL 60073-1896
Phone (847) 377-8800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178004336ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
County of Lake Current Accepting new patients
County of Lake CurrentSince Jan 1, 2024 Accepting new patients
County of Lake CurrentSince Jan 1, 2024 Accepting new patients

Locations

224 W Clarendon Dr
Round Lake Beach, IL 60073
Phone (847) 377-8800

2400 Belvidere Rd
Waukegan, IL 60085
Phone (847) 377-8400

3010 Grand Ave
Waukegan, IL 60085
Phone (847) 377-8296

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, 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": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1114291911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321",
            "telephone_number": "847-377-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "TODD",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-27",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178004336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.