Individual provider Active NPI

Amy Malin

  • Counselor
  • Broken Arrow, OK
National Provider Identifier
1396024774
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
8937 S Garnett Rd
Broken Arrow, OK 74012-6018
Phone
(918) 872-9777
Fax
(918) 872-9779
NPI assigned
Aug 16, 2011
Last updated
Feb 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

8937 S Garnett Rd
Broken Arrow, OK 74012-6018

Mailing address

6301 E 41St St
Tulsa, OK 74135-6103
Phone (918) 289-0550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20241105002915 OK Practitioner - Mental Health Counselor 4688108210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jeffrey K McIlroy MD IncGroup PAC ID 8527962216, 13 clinicians

Practice addresses (Care Compare)

8937 S Garnett Rd
Broken Arrow, OK 74012-6004
Phone (918) 872-9777

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jeffrey K McIlroy MD Inc CurrentSince Jul 26, 2024 Accepting new patients

Locations

8937 S Garnett Rd
Broken Arrow, OK 74012
Phone (918) 342-2622

2990 N Sioux Ave
Claremore, OK 74017
Phone (918) 342-2622

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": "1313452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1396024774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 E 41ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356103",
            "telephone_number": "918-289-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8937 S GARNETT RD",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126018",
            "telephone_number": "918-872-9777",
            "fax_number": "918-872-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALIN",
        "first_name": "AMY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-16",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

Verify at the official NPI Registry.