Active NPI
Brandon Keith Miller, LSW
- Social Worker
- Champaign, IL
National Provider Identifier
1255940599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.104394
- Practice address
- 309 W Clark St
Champaign, IL 61820-4637 - Phone
- (217) 398-9066
- Fax
- (217) 398-9077
- NPI assigned
- Jul 22, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.104394 | IL | Primary |
Addresses
Primary practice location
309 W Clark St
Champaign, IL 61820-4637
Mailing address
403 Compton Ave
Champaign, IL 61822-7353
Phone (331) 425-5283
Other practice location 1
704 N Main St
Tuscola, IL 61953-1000
Phone (217) 398-9066
Other practice location 2
2001 Philo Rd
Urbana, IL 61802-8007
Phone (217) 398-9066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150.104394 | IL | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stillwater Mental Health Services PLLC | Current | Accepting new patients |
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 and National Provider Directory roles.
-
- Mental Health Counselor
- Champaign, IL
- NPI 1598620528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601424000000",
"number": "1255940599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 COMPTON AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618227353",
"telephone_number": "331-425-5283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 W CLARK ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618204637",
"telephone_number": "217-398-9066",
"fax_number": "217-398-9077"
}
],
"practiceLocations": [
{
"address_1": "704 N Main St",
"address_purpose": "LOCATION",
"city": "Tuscola",
"state": "IL",
"postal_code": "619531000",
"country_code": "US",
"telephone_number": "217-398-9066",
"fax_number": "217-398-9077",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2001 Philo Rd",
"address_purpose": "LOCATION",
"city": "Urbana",
"state": "IL",
"postal_code": "618028007",
"country_code": "US",
"telephone_number": "217-398-9066",
"fax_number": "217-398-9077",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MILLER",
"first_name": "BRANDON",
"middle_name": "KEITH",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-22",
"last_updated": "2020-09-30",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.104394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.