Jill Rene Mullins, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801093221 Issued in MI

Practice address

6130 Lovers LN
Portage, MI 49002-3026

Phone

(269) 501-5017

NPI assigned

Jan 3, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jill Vickery Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Rooted Minds LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Kalamazoo, MI
  • NPI 1932912425
  Medicare reassignment

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

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1477890960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 N 5TH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490098509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6130 LOVERS LN",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023026",
            "telephone_number": "269-501-5017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "JILL",
        "middle_name": "RENE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-03",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801093221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "VICKERY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Cresentia Mrazek, LMSW
• Ashley Kate Muehleise, DDS
• Marissa C Mueller
• Chad E Muffley, MA LLP
• Susan Camille Muinch, MA, LPC
• Brenda Mumbower
• Bernard Mun
• Munificent Care LLC
• Laci Murdock
• Ericka Lynn Murnighan

• Social Worker in Portage, MI
• Providers in Portage, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.