Individual provider Active NPI

Sandra Ann Miller, LCSW

  • Clinical Social Worker
  • Chattanooga, TN
National Provider Identifier
1245337724
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LSW0000004174 Issued in TN
Practice address
6011 Shallowford Rd
Chattanooga, TN 37421
Phone
(800) 632-6074
Fax
(866) 341-7509
NPI assigned
Sep 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 LSW0000004174 TN Primary

Addresses

Primary practice location

6011 Shallowford Rd
Chattanooga, TN 37421

Mailing address

PO Box 10414
Largo, FL 33773
Phone (800) 632-6074

Other identifiers 1

IdentifierTypeStateIssuer
3926743MedicaidTN

Other names 1

  • Sandra Ann Blackburn Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20060315000072 TN Practitioner - Clinical Social Worker 3173530268 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LSW0000004174TNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Volunteer Behavioral Health Care System CurrentSince Jun 8, 2020 Accepting new patients

Locations

413 Spring St
Chattanooga, TN 37405
Phone (423) 756-2740

2700 Executive Park NW
Cleveland, TN 37312
Phone (423) 479-9581

1200 S Willow Ave
Cookeville, TN 38506
Phone (931) 432-0890

118 N Church St
Murfreesboro, TN 37130
Phone (615) 278-2241

Interoperability endpoints

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

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245337724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10414",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "33773",
            "telephone_number": "800-632-6074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6011 SHALLOWFORD RD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37421",
            "telephone_number": "800-632-6074",
            "fax_number": "866-341-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SANDRA",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "LSW0000004174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3926743",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "BLACKBURN",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.