Active NPI
Tyler W. Loder, LSCSW
- Clinical Social Worker
- Eglin Afb, FL
National Provider Identifier
1053658369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4320
- Practice address
- 307 Boatner Rd Ste 114
Eglin Afb, FL 32542-1302 - Phone
- (850) 883-8600
- NPI assigned
- Jan 7, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4320 | KS | Primary |
Addresses
Primary practice location
307 Boatner Rd Ste 114
Eglin Afb, FL 32542-1302
Mailing address
307 Boatner Rd Ste 114
Eglin Afb, FL 32542-1302
Phone (850) 883-8600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4320 | KS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677542400000",
"number": "1053658369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 BOATNER RD STE 114",
"city": "EGLIN AFB",
"state": "FL",
"postal_code": "325421302",
"telephone_number": "850-883-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 BOATNER RD STE 114",
"city": "EGLIN AFB",
"state": "FL",
"postal_code": "325421302",
"telephone_number": "850-883-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODER",
"first_name": "TYLER",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "LSCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-07",
"last_updated": "2023-02-28",
"certification_date": "2023-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KS",
"license": "4320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eglin Afb, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.