Active NPI
Kyle William Miller, LCSW
- Clinical Social Worker
- Eldorado, IL
National Provider Identifier
1629744917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 1200 Locust St
Eldorado, IL 62930-1723 - Phone
- (618) 697-8005
- NPI assigned
- Aug 18, 2021
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
1200 Locust St
Eldorado, IL 62930-1723
Mailing address
1200 Locust St
Eldorado, IL 62930-1723
Phone (618) 687-8005
Other practice location 1
1400 N Wood Rd
Murphysboro, IL 62966-6290
Phone (618) 687-8005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 4, 2024 through Mar 4, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629244800000",
"number": "1629744917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 LOCUST ST",
"city": "ELDORADO",
"state": "IL",
"postal_code": "629301723",
"telephone_number": "618-687-8005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 LOCUST ST",
"city": "ELDORADO",
"state": "IL",
"postal_code": "629301723",
"telephone_number": "618-697-8005"
}
],
"practiceLocations": [
{
"address_1": "1400 N Wood Rd",
"address_purpose": "LOCATION",
"city": "Murphysboro",
"state": "IL",
"postal_code": "629666290",
"country_code": "US",
"telephone_number": "618-687-8005",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MILLER",
"first_name": "KYLE",
"middle_name": "WILLIAM",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-18",
"last_updated": "2021-08-18",
"certification_date": "2021-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eldorado, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.