Individual provider Active NPI

Fred F Boykin, MSW

  • Clinical Social Worker
  • Wilton Manors, FL
National Provider Identifier
1003916602
Registry record updated Dec 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW14084 Issued in FL
Practice address
2312 Wilton Dr
Ste 29
Wilton Manors, FL 33305-1249
Phone
(301) 404-3602
Fax
(301) 576-3538
NPI assigned
Sep 23, 2006
Last updated
Dec 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW14084 FL Primary

Addresses

Primary practice location

2312 Wilton Dr
Ste 29
Wilton Manors, FL 33305-1249

Mailing address

333 Las Olas Way Apt 2304
Fort Lauderdale, FL 33301-2388
Phone (301) 404-3602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170622002664 FL Practitioner - Clinical Social Worker 6204992258 Practice locations: Fort Lauderdale, FL; Wilton Manors, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2312 Wilton Dr
Suite 29
Wilton Manors, FL 33305-1249
Phone (301) 404-3602

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
07765MDMDPharmacist

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670025600000",
    "number": "1003916602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LAS OLAS WAY APT 2304",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333012388",
            "telephone_number": "301-404-3602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 WILTON DR",
            "address_2": "STE 29",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051249",
            "telephone_number": "301-404-3602",
            "fax_number": "301-576-3538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYKIN",
        "first_name": "FRED",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2022-12-03",
        "certification_date": "2022-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW14084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilton Manors, FL

Sources for this page

Verify at the official NPI Registry.