Individual provider Active NPI

Mark Miller

  • Clinical Social Worker
  • Joplin, MO
National Provider Identifier
1790239572
Registry record updated May 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2019014404 Issued in MO
Practice address
3901 E 32ND St
Joplin, MO 64804-3312
Phone
(417) 347-7600
NPI assigned
Aug 9, 2016
Last updated
May 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2016026179 MO
Clinical Social Worker 1041C0700X 2019014404 MO Primary

Addresses

Primary practice location

3901 E 32ND St
Joplin, MO 64804-3312

Mailing address

PO Box 2526
Joplin, MO 64803-2526
Phone (417) 347-7579

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20190520000103 MO Practitioner - Clinical Social Worker 0143563940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ozark CenterGroup PAC ID 4789588088, 38 clinicians

Practice addresses (Care Compare)

3901 E 32ND St
Joplin, MO 64804-3312
Phone (417) 347-7600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2016026179MOMDClinical Social Worker
2019014404MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ozark Center CurrentSince May 6, 2019 Accepting new patients
Ozark Center CurrentSince May 6, 2019 Accepting new patients

Locations

3901 E 32nd St
Joplin, MO 64804
Phone (417) 347-7567

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1790239572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2526",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648032526",
            "telephone_number": "417-347-7579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 E 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648043312",
            "telephone_number": "417-347-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-09",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2016026179",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2019014404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

Verify at the official NPI Registry.