Melissa A Mitsdarffer, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014583 Issued in IL

Practice address

1016 S Madison St
Suite a
Du Quoin, IL 62832-2442

Phone

(618) 542-4357

Fax

(618) 542-3442

NPI assigned

Mar 22, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Integrated Health of Southern Illinois LTDGroup PAC ID 2365401122, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: melissa.mitsdarffer.1@26231.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/26231/brand/1/csg/1/fhir/r4

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.

• Integrated Health of Southern Illinois, LTD.

  • Sports Medicine (Family Medicine) Physician
  • Harrisburg, IL
  • NPI 1982738274
  Medicare reassignment Care Compare group NPD
• Integrated Health of Southern Illinois

  • Family Medicine Physician
  • Carterville, IL
  • NPI 1790235497
  NPD
• Naeem a Qureshi PC

  • Psychiatry Physician
  • Marion, IL
  • NPI 1467492298
  NPD (past)

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300752000000",
    "number": "1891094496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 S MADISON ST",
            "address_2": "SUITE A",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628322442",
            "telephone_number": "618-542-4357",
            "fax_number": "618-542-3442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 S MADISON ST",
            "address_2": "SUITE A",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628322442",
            "telephone_number": "618-542-4357",
            "fax_number": "618-542-3442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITSDARFFER",
        "first_name": "MELISSA",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-22",
        "last_updated": "2011-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda McFadden
• Savanna McFadden
• Med Motion Supply LLC
• Michael Dean Melvin, RPH
• Gorana Micevic
• Derek Mohr, BA
• Anthony Bryant Moran, LPC
• Ashley Nicole Morgan, RN
• Alan Gene Morris, R.PH.
• Christina Murphy, LPN

• Clinical Social Worker in Du Quoin, IL
• Providers in Du Quoin, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; 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.

Verify at the official NPI Registry.