Active NPI
Kim Roberts, LCSW
- Clinical Social Worker
- Tampa, FL
National Provider Identifier
1265014179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW18330
- Practice address
- 3515 E Fletcher Ave
Tampa, FL 33613-4706 - Phone
- (813) 821-8038
- NPI assigned
- Apr 21, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 090634-01 | NY | |
| Clinical Social Worker | 1041C0700X | 0904012945 | VA | |
| Clinical Social Worker | 1041C0700X | SW18330 | FL | Primary |
Addresses
Primary practice location
3515 E Fletcher Ave
Tampa, FL 33613-4706
Mailing address
PO Box 917770
Orlando, FL 32891-0001
Other practice location 1
1000 Jefferson St Ste 2C
Lynchburg, VA 24504-1724
Phone (540) 217-6461
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114733700 | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kroberts244912@direct.tgh.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Promoting interoperability
- 0
- Improvement activities
- 0
- Cost
- 0
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 090634-01 | NY | MD | Clinical Social Worker |
| 0904012945 | VA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thriveworks Clinical - Florida Inc | Current | Accepting new patients |
Locations
2425 E Commercial Blvd
Ste 405
Fort Lauderdale, FL 33308
Phone (754) 400-5514
4115 W Spruce St
Ste 205
Tampa, FL 33607
Phone (813) 413-4663
1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263
Interoperability endpoints
- kroberts244912@direct.tgh.org
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662076800000",
"number": "1265014179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 917770",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328910001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3515 E FLETCHER AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "336134706",
"telephone_number": "813-821-8038"
}
],
"practiceLocations": [
{
"address_1": "1000 Jefferson St Ste 2C",
"address_purpose": "LOCATION",
"city": "Lynchburg",
"state": "VA",
"postal_code": "245041724",
"country_code": "US",
"telephone_number": "540-217-6461",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROBERTS",
"first_name": "KIM",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-21",
"last_updated": "2022-09-02",
"certification_date": "2022-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "090634-01",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904012945",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW18330",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114733700",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kroberts244912@direct.tgh.org",
"affiliation": "N",
"address_1": "3515 E Fletcher Ave",
"city": "Tampa",
"state": "FL",
"country_code": "US",
"postal_code": "336134706",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.