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Deactivated NPI 1093149452 Deactivated / Inactive NPI Female Practitioner

Melissa Buckley

Social Worker • Dixon, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Melissa Buckley has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 21, 2013
NPI Deactivation Date November 09, 2022
Total Practice Duration ~3 Years of Practice (2019 – 2022)

Professional Overview & Biography Verified Profile Summary

Melissa Buckley was a registered Social Worker practicing in Dixon, IL. Throughout an active medical career spanning 3 years, Melissa Buckley provided care at the practice location at 325 IL ROUTE 2 until profile deactivation on 2022-11-09.

Melissa Buckley did not directly accept Medicare assignment.

Historical Medicare Part B clinical services included psychotherapy. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

325 Il Route 2

Dixon, IL 610219118

Telephone 8152846611
Associated Practice Facility / Clinic
🏢 Sinnissippi Centers, Inc. Facility NPI 1922114115

Medicare Profile & Education

Medical School

Other

Graduation Year

2019

Medicare Assignment

Not Specified

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Social Worker in Dixon, IL

Experienced Practitioner (5-10 Yrs)
Practitioner Clinical Experience
7 Yrs -1.6 yrs vs City Avg
City Avg: 8.6 Yrs
State Avg: 13.0 Yrs
Regional Practice Density
47 Specialists

Practicing in Dixon, IL (5960 Statewide)

Telehealth Adoption Rate
4.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
31.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Buckley (7 Years) 7 Yrs
Dixon Specialty Average (8.6 Years) 8.6 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2023)
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
90832 Psychotherapy, 30 minutes
40 12 $80.00 $54.98

Medical Specialties & State Licenses

CMS Verified: 2023-06-04
Social Worker Primary Specialty

NUCC Taxonomy Code: 104100000X

State License IL 149.024911

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

State License IL 149.024911

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Wendy Wiersema , LPN

Licensed Practical Nurse

NPI 1003363482

Licensed Practical Nurse

Rae Metzler8

Counselor - Mental Health

NPI 1003416520
Madison Wallace , MHP

Counselor - Mental Health

NPI 1003622937

Mental Health Practitioner

Leigh Terrell , LCPC

Counselor - Mental Health

NPI 1013057868

Licensed Clinical Professional Counselor

NPI 1013567973
Michael Swiech

Counselor - Mental Health

NPI 1013684364

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 05, 2023

Social Worker (License #149.024911 in IL)

📍
Updated Practice Location January 27, 2023

Registered at 325 IL ROUTE 2, DIXON, IL 610219118 (Tel: 8152846611)

📍
Updated Practice Location January 03, 2023

Registered at 4043 N RAVENSWOOD AVE, CHICAGO, IL 606131155 (Tel: 6302779256)

📍
Updated Business Mailing Address January 03, 2023

Registered at 311 W PARK ST, MORRISON, IL 612702319 (Tel: 8152134389)

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Provider Name / Credentials Updated January 03, 2023

Recorded as MELISSA BUCKLEY

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 03, 2023

Counselor (License #149.024911 in IL)

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NPI Profile Deactivated November 09, 2022

Record deactivated on November 09, 2022

NPI Profile Active August 21, 2013

NPI status registered as active in NPPES database

📍
Updated Practice Location August 21, 2013

Registered at 2104 E 23RD ST, STERLING, IL 610811608 (Tel: 8156220938)

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Updated Business Mailing Address August 21, 2013

Registered at 1501 LOWELL PARK RD APT 2O, DIXON, IL 610219239 (Tel: 8152175543)

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Provider Name / Credentials Updated August 21, 2013

Recorded as MELISSA OSORIO

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 21, 2013

Counselor

🟢
Initial NPI Registration & Enumeration August 21, 2013

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1093149452
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 21, 2013
Last Update: June 05, 2023
Deactivation Date: November 09, 2022
Sole Proprietor: No

Mailing Address

311 W Park St

Morrison, IL 612702319

Phone: 8152134389

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.