Jennifer S Mellin, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036111512 Issued in IL

Practice address

518 Lucinda Ave
Niu Health Services
Dekalb, IL 60115

Phone

(815) 753-9587

NPI assigned

Jul 19, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Larc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Lansing, IL
  • NPI 1245695733
  NPD (past)
• Rehab Services SL, S.C.

  • Psychiatry Physician
  • Chicago, IL
  • NPI 1982932497
  NPD (past)
• Riaz Baber MD SC

  • Counseling Psychologist
  • Naperville, IL
  • NPI 1295956522
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479081600000",
    "number": "1932128808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 LAKEWOOD DR",
            "address_2": "STE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604503352",
            "telephone_number": "815-942-6323",
            "fax_number": "815-942-6323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 LUCINDA AVE",
            "address_2": "NIU HEALTH SERVICES",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "60115",
            "telephone_number": "815-753-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLIN",
        "first_name": "JENNIFER",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2016-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036111512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP",
            "identifier": "CE9335",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE #",
            "identifier": "P00345212",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick McMillion
• Natalie R Meckstroth, MA, ATC
• Medicine Shoppe of Dekalb Inc
• Kristen Angela Melchiori, MSW, CADC
• Alexis Melendez
• Jazlynn Mendoza
• Samantha Mendoza
• Cristina Mercado
• Evens Mesadieu, APRN, CRNA
• Haley Metcalf, BA

• Psychiatry Physician in Dekalb, IL
• Providers in Dekalb, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.