Individual provider Active NPI

Jeremiah Keith Miller, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Barrington, IL
National Provider Identifier
1891592523
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
209032365 Issued in IL
Practice address
111 Lions Dr Ste 210
Barrington, IL 60010-3175
Phone
(630) 428-7890
NPI assigned
Feb 28, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209032365 IL Primary

Addresses

Primary practice location

111 Lions Dr Ste 210
Barrington, IL 60010-3175

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630
Phone (630) 428-7890

Other practice location 1

500 Coventry Ln Ste 205
Crystal Lake, IL 60014-7555
Phone (815) 455-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260114002494 IL Practitioner - Nurse Practitioner 8628554169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

111 Lions Dr
Suite 210
Barrington, IL 60010-3175
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209032365ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. Psychiatric/Mental Health CurrentSince Jan 5, 2026 Accepting new patients
Psychology Specialists LTD Past Accepting new patients
Edgewood Clinical Services, P.C. Past Accepting new patients
Horizons Behavioral Health LLC PastSince Mar 11, 2025 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

111 Lions Dr
Ste 210
Barrington, IL 60010
Phone (847) 304-0044

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

Organizations & group practices 4

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": "1740700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767744000000",
    "number": "1891592523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "630-428-7890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LIONS DR STE 210",
            "city": "BARRINGTON",
            "state": "IL",
            "postal_code": "600103175",
            "telephone_number": "630-428-7890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Coventry Ln Ste 205",
            "address_purpose": "LOCATION",
            "city": "Crystal Lake",
            "state": "IL",
            "postal_code": "600147555",
            "country_code": "US",
            "telephone_number": "815-455-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JEREMIAH",
        "middle_name": "KEITH",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-28",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209032365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Barrington, IL

Sources for this page

Verify at the official NPI Registry.