Active NPI
Mark E. Miller, LICSW, LISW, LSCSW
- Mental Health Counselor
- Omaha, NE
National Provider Identifier
1912013392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1199
- Practice address
- 12035 Q St
Omaha, NE 68137-3542 - Phone
- (402) 991-0611
- Fax
- (402) 991-6228
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 05745 | KS | |
| Clinical Social Worker | 1041C0700X | 06756 | IA | |
| Clinical Social Worker | 1041C0700X | 1413 | NE | |
| Mental Health Counselor | 101YM0800X | 1199 | NE | Primary |
Addresses
Primary practice location
12035 Q St
Omaha, NE 68137-3542
Mailing address
12035 Q Street
Omaha, NE 68137-3542
Phone (402) 991-0611
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IB158001 | Other | IA | MEDICARE PTAN |
| NA3245001 | Other | NE | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA, NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
12035 Q St
Omaha, NE 68137-3542
Phone (402) 991-0611
2701 N 8TH St
Red Oak, IA 51566-1151
Phone (402) 991-0611
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05745 | KS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spence Counseling Center PC | Mental Health | Current | Accepting new patients |
Locations
239 Frank St
Council Bluffs, IA 51503
Phone (402) 991-0611
2701 N 8th St
Red Oak, IA 51566
Phone (402) 991-0611
12035 Q St
Omaha, NE 68137
Phone (402) 704-7814
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": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1912013392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12035 Q STREET",
"city": "OMAHA",
"state": "NE",
"postal_code": "681373542",
"telephone_number": "402-991-0611",
"fax_number": "402-991-6228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12035 Q ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681373542",
"telephone_number": "402-991-0611",
"fax_number": "402-991-6228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MARK",
"middle_name": "E.",
"name_prefix": "Mr.",
"credential": "LICSW, LISW, LSCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KS",
"license": "05745",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IA",
"license": "06756",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NE",
"license": "1413",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NE",
"license": "1199",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "IB158001",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "NA3245001",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.