Active NPI
Mildred Sue Dukic
- Professional Counselor
- Clarksville, TN
National Provider Identifier
1750775367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3234
- Practice address
- 512 Madison St
3
Clarksville, TN 37040-3671 - Phone
- (615) 604-6000
- NPI assigned
- Mar 20, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3234 | TN | Primary |
Addresses
Primary practice location
512 Madison St
3
Clarksville, TN 37040-3671
Mailing address
512 Madison St
3
Clarksville, TN 37040-3671
Phone (615) 604-6000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
Knoxville, TN 37923
Phone (415) 360-3348
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3234 | TN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brightside Medical, P.C. | Current | Accepting new patients |
Locations
2261 Market St
San Francisco, CA 94114
Phone (213) 337-4615
8913 Town and Country Cir
Knoxville, TN 37923
Phone (253) 861-0739
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426809600000",
"number": "1750775367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "512 MADISON ST",
"address_2": "3",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370403671",
"telephone_number": "615-604-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "512 MADISON ST",
"address_2": "3",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370403671",
"telephone_number": "615-604-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUKIC",
"first_name": "MILDRED",
"middle_name": "SUE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-03-20",
"last_updated": "2015-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TN",
"license": "3234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.