Mary Mims

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34006323A Issued in IN

Practice address

1051 185TH St
Homewood, IL 60430-3509

Phone

(708) 903-7689

NPI assigned

Jan 7, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mary Mims Professional name

Medicare fee-for-service enrollment

Enrolled in IL, IN2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2002

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Sondermind PCGroup PAC ID 0547795791, 64 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sondermind PC

  • Clinical Social Worker
  • San Jose, CA
  • NPI 1003646977

  IL

  Medicare reassignment Care Compare group NPD
• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  IN

  Medicare reassignment Care Compare group NPD
• Blue Moon Senior Counseling of Illinois LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1841562931
  Medicare reassignment NPD
• BMSC Az LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1497201875

  IN

  Medicare reassignment NPD

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

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1174989016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 185TH ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604303509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 185TH ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604303509",
            "telephone_number": "708-903-7689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMS",
        "first_name": "MARY",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-07",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149022074",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006323A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MIMS",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jillian Andrea Miller
• Kyle Raymond Miller, MA
• Sheree N Miller
• Stacie Danielle Miller
• Ruth Ann Mills, CHIROPRACTOR
• Mindful Wellness Counseling
• Mindful Wellness Counseling Group
• Minds Empowered Counseling
• Minds Empowered Counseling Services LLC
• Rachel Cortney Minkel

• Clinical Social Worker in Homewood, IL
• Providers in Homewood, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.