Individual provider Active NPI

Benjamin Mullineaux, LCSW

  • Clinical Social Worker
  • Roscoe, IL
National Provider Identifier
1164925848
Registry record updated Mar 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
10126 Clearwing LN
Roscoe, IL 61073-5613
Phone
(618) 203-2927
NPI assigned
Mar 8, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 8, 2018

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 Primary

Addresses

Primary practice location

10126 Clearwing LN
Roscoe, IL 61073-5613

Mailing address

10126 Clearwing LN
Roscoe, IL 61073-5613
Phone (618) 203-2927

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
I20240523000192 IL Practitioner - Mental Health Counselor 7517309479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kathleen E Cox PCGroup PAC ID 3173962339, 3 clinicians

Practice addresses (Care Compare)

5290 Williams Dr
Roscoe, IL 61073-9222
Phone (815) 324-0324

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kathleen E Cox PC Clinical CurrentSince Apr 10, 2024 Accepting new patients

Locations

5290 Williams Dr
Roscoe, IL 61073
Phone (815) 324-0324

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": "1520467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520467200000",
    "number": "1164925848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10126 CLEARWING LN",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610735613",
            "telephone_number": "618-203-2927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10126 CLEARWING LN",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610735613",
            "telephone_number": "618-203-2927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINEAUX",
        "first_name": "BENJAMIN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-08",
        "last_updated": "2018-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roscoe, IL

Sources for this page

Verify at the official NPI Registry.