Individual provider Active NPI

Mia G Perry, LCSW

  • Clinical Social Worker
  • Georgetown, KY
National Provider Identifier
1891047429
Registry record updated Jan 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5032 Issued in KY
Practice address
1236 Paris Pike
Georgetown, KY 40324-9701
Phone
(502) 370-7229
NPI assigned
Oct 5, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 5032 KY Primary

Addresses

Primary practice location

1236 Paris Pike
Georgetown, KY 40324-9701

Mailing address

2385 Randolph CT
Lexington, KY 40503-2620
Phone (215) 605-5373

Other identifiers 1

IdentifierTypeStateIssuer
1790731081MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20180828001027 KY Practitioner - Clinical Social Worker 7719236561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

100 Executive Park
Suite 103
Louisville, KY 40207-4201
Phone (502) 552-5068

1030 Monarch St
Suite 100
Lexington, KY 40513-1820
Phone (844) 468-5050

120 Prosperous PL
Suite 201
Lexington, KY 40509-1866
Phone (216) 468-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Psychological & Behavioral Consultants, LLC Clinical CurrentSince Sep 1, 2018 Accepting new patients

Locations

120 Prosperous Pl
Ste 201
Lexington, KY 40509
Phone (859) 368-0609

120 Prosperous Pl
Ste 150
Lexington, KY 40509
Phone (859) 214-7440

100 Executive Park
Ste 103
Louisville, KY 40207
Phone (502) 313-6880

Interoperability endpoints

  • Direct secure messaging: bbh.miaperry@140103.advancedmd-direct.com

Organizations & group practices 1

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": "1349395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515715200000",
    "number": "1891047429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2385 RANDOLPH CT",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405032620",
            "telephone_number": "215-605-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 PARIS PIKE",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249701",
            "telephone_number": "502-370-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "MIA",
        "middle_name": "G",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-05",
        "last_updated": "2018-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "5032",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790731081",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, KY

Sources for this page

Verify at the official NPI Registry.