John Clark Miller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

L5461 Issued in OR

Practice address

60 Laneda Avenue
Suite 202
Manzanita, OR 97130-0000

Phone

(971) 324-0061

Fax

(971) 606-2001

NPI assigned

Mar 29, 2007

Last updated

Apr 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/tfcc/r4/

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.

• Tillamook Family Counseling Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Tillamook, OR
  • NPI 1063623478
  NPD (past)
• Tillamook Family Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tillamook, OR
  • NPI 1659380145
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1174643738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 146",
            "city": "ROCKAWAY BEACH",
            "state": "OR",
            "postal_code": "971360146",
            "telephone_number": "541-377-1631",
            "fax_number": "971-606-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 LANEDA AVENUE",
            "address_2": "SUITE 202",
            "city": "MANZANITA",
            "state": "OR",
            "postal_code": "971300000",
            "telephone_number": "971-324-0061",
            "fax_number": "971-606-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JOHN",
        "middle_name": "CLARK",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "12-03-71",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500671647",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie E Ehrke, LMT
• August A Fineout, APRN
• Scott Thomas Galvin
• Judi Hanson
• Longevity
• Deb Montgomery, LMHC
• Northwest Medical Foundation of Tillamook (Adventist Health/Tillamook Medical Group Manzanita Primary & Specialty)
• Orthopedic Toe Guard
• Pauseful LLC (Pauseful Massage & Botanicals)
• Amy Pulitzer, MA, LPC, MFT

• Clinical Social Worker in Manzanita, OR
• Providers in Manzanita, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.

Verify at the official NPI Registry.