Millie Riss Funderburk, PSYD, LPC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5295 Issued in CO

Practice address

1705 S Pearl St
Unit 4
Denver, CO 80210-3170

Phone

(303) 818-1284

NPI assigned

Aug 4, 2010

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

• Dr. Millie Margaret Riss Former name

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280880000000",
    "number": "1609180413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 S PEARL ST",
            "address_2": "UNIT 4",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802103170",
            "telephone_number": "303-818-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 S PEARL ST",
            "address_2": "UNIT 4",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802103170",
            "telephone_number": "303-818-1284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK",
        "first_name": "MILLIE",
        "middle_name": "RISS",
        "name_prefix": "Dr.",
        "credential": "PSYD, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-04",
        "last_updated": "2010-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "5295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MILLIE",
            "last_name": "RISS",
            "middle_name": "MARGARET",
            "prefix": "DR.",
            "credential": "PSYD, LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sadie Fulton
• Functional Performance PT Center
• Functional Performance PT Center
• Functional Physical Therapy, LLC, a Colorado Professional Company
• Sara Funderburg
• Aziza Fundi
• Philip H Fung, MD
• Victoria Funk-Diaz, LPTA, RN
• Gregory W Funk, D.C.
• Jessica Lee Funk, REGISTERED NURSE

• Clinical Psychologist in Denver, CO
• Providers in Denver, CO by specialty
• Clinical Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.