Active NPI
Kadian Samantha Miracle
- Clinical Psychologist
- Granville, OH
National Provider Identifier
1376109892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P.7565
- Practice address
- 100 West College Street
Whisler Hall
Granville, OH 43023 - Phone
- (740) 274-5792
- NPI assigned
- May 10, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P.7565 | OH | Primary |
| Health Service Psychologist | 103TH0100X | P.7565 | OH |
Addresses
Primary practice location
100 West College Street
Whisler Hall
Granville, OH 43023
Mailing address
5806 Warner Meadows Dr
Westerville, OH 43081-8694
Phone (740) 274-5792
Other practice location 1
570 N State St Ste 210
Westerville, OH 43082-7135
Phone (740) 274-5792
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 |
|---|---|---|---|
| P.7565 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557446400000",
"number": "1376109892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5806 WARNER MEADOWS DR",
"city": "WESTERVILLE",
"state": "OH",
"postal_code": "430818694",
"telephone_number": "740-274-5792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WEST COLLEGE STREET",
"address_2": "WHISLER HALL",
"city": "GRANVILLE",
"state": "OH",
"postal_code": "43023",
"telephone_number": "740-274-5792"
}
],
"practiceLocations": [
{
"address_1": "570 N State St Ste 210",
"address_purpose": "LOCATION",
"city": "Westerville",
"state": "OH",
"postal_code": "430827135",
"country_code": "US",
"telephone_number": "740-274-5792",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIRACLE",
"first_name": "KADIAN",
"middle_name": "SAMANTHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-10",
"last_updated": "2019-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "P.7565",
"primary": true
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "OH",
"license": "P.7565",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granville, OH
- Cynthia McElroy, LISW
- Leslie McNemar, LMT
- Cheryl Meisterman, PHD
- Mid-Ohio Counseling, LLC
- Midwest Dermatology Centre LLC
- Katherine L. Montanaro, CNP
- Sarah Toon Moore
- William J. Morris, M.D.
- Mount Carmel Health Providers Inc (Welsh Hills Family Health)
- Mount Carmel Health Providers Two LLC (Mount Carmel Neurology Providers at Granville)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.