Active NPI
Cheryl Miracle, LCSW
- Clinical Social Worker
- Kokomo, IN
National Provider Identifier
1639356223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34005876A
- Practice address
- 3409 S 200 W
Kokomo, IN 46902-9613 - Phone
- (260) 563-8453
- NPI assigned
- Jan 25, 2008
- Sex
- Female
- 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 | 34005876A | IN | Primary |
Addresses
Primary practice location
3409 S 200 W
Kokomo, IN 46902-9613
Mailing address
3563 S State Road 13
Wabash, IN 46992-9162
Phone (260) 563-8453
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000671582 | Other | IN | BLUE CROSS BLUE SHIELD |
| 9478593 | Other | IN | AETNA |
| 600642605 | Other | IN | MAGELLAN |
| 201097990 | Medicaid | IN | |
| 000542210 | Other | IN | UNITED BEHAVIORAL HEALTH |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34005876A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1639356223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3563 S STATE ROAD 13",
"city": "WABASH",
"state": "IN",
"postal_code": "469929162",
"telephone_number": "260-563-8453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3409 S 200 W",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469029613",
"telephone_number": "260-563-8453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRACLE",
"first_name": "CHERYL",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-25",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34005876A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000000671582",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "9478593",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "600642605",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201097990",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "000542210",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kokomo, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.