Individual provider Active NPI

Mark E. Miller, LICSW, LISW, LSCSW

  • Mental Health Counselor
  • Omaha, NE
National Provider Identifier
1912013392
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1199 Issued in NE
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

Updated by the provider on Aug 22, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
IB158001OtherIAMEDICARE PTAN
NA3245001OtherNEMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, NE2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20091217000564 IA Practitioner - Clinical Social Worker 6901946227 Reassigns benefits to 1 organization
I20180131002900 NE Practitioner - Clinical Social Worker 6901946227 Reassigns benefits to 1 organization

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
Spence Counseling Center PCGroup PAC ID 6204976525, 14 clinicians

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

LicenseStateTypeSpecialty
05745KSMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Spence Counseling Center PC Mental Health CurrentSince Sep 28, 2009 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

Verify at the official NPI Registry.