Individual provider Active NPI

Jared Mueller, LISW

  • Clinical Social Worker
  • Centerville, OH
National Provider Identifier
1255659579
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.1700106 Issued in OH
Practice address
6661 Clyo Rd
Centerville, OH 45459-2767
Phone
(937) 425-4000
Fax
(937) 425-4002
NPI assigned
May 11, 2010
Last updated
Dec 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Clinical Social Worker 1041C0700X I.1700106 OH Primary

Addresses

Primary practice location

6661 Clyo Rd
Centerville, OH 45459-2767

Mailing address

1 Prestige PL Ste 550
Miamisburg, OH 45342-6115
Phone (937) 762-1310

Other practice location 1

425 N Findlay St
Dayton, OH 45404-2203
Phone (937) 474-8772

Other names 1

  • Jared K Mueller Professional name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jmueller660446@direct.ketteringhealth.org
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20190618002754 OH Practitioner - Clinical Social Worker 7416281811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Ohio State University College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

4172 Indian Ripple Rd
Suite B
Beavercreek, OH 45440-3286
Phone (937) 490-2090

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.1700106OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc CurrentSince May 28, 2023 Accepting new patients

Locations

4172 Indian Ripple Rd
Ste B
Dayton, OH 45440
Phone (937) 490-2090

6661 Clyo Rd
Dayton, OH 45459
Phone (937) 425-4000

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

2115 Leiter Rd
Miamisburg, OH 45342
Phone (937) 384-6920

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": "1273536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1255659579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310",
            "fax_number": "937-522-8493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6661 CLYO RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454592767",
            "telephone_number": "937-425-4000",
            "fax_number": "937-425-4002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 N Findlay St",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454042203",
            "country_code": "US",
            "telephone_number": "937-474-8772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUELLER",
        "first_name": "JARED",
        "name_prefix": "Mr.",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-11",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1700106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmueller660446@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "6661 Clyo Rd",
            "city": "Centerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454592767",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "6661 Clyo Rd",
            "city": "Centerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454592767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JARED",
            "last_name": "MUELLER",
            "middle_name": "K",
            "credential": "LISW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Centerville, OH

Sources for this page

Verify at the official NPI Registry.