Shaun David Tobler, MSW, LCSW
Individual provider Active NPI Clinical Social Worker · Montpelier, ID
NPI 1295891844 · NPPES record last updated Mar 16, 2021
Key facts
- NPI
- 1295891844
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW-1243 (ID)
- Practice address
- 455 Washington St Ste 2
Montpelier, ID 83254-1600 - Phone
- (208) 847-4464
- Fax
- (208) 847-3093
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bear Lake County Memorial Hospital
Practice addresses (Care Compare)
822 Washington St
Montpelier, ID 83254-1423
Phone (208) 847-4464
Hospital & facility affiliations
- Bear Lake Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060113000509 | ID | Practitioner - Clinical Social Worker | 5496778672 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bear Lake County Memorial Hospital | Current |
Accepting new patients | |
| Bear Lake County Memorial Hospital | Current | Accepting new patients | |
| Bear Lake County Memorial Hospital | Current |
Accepting new patients | |
| Bear Lake County Memorial Hospital | Current | Accepting new patients | |
| Bear Lake County Memorial Hospital | Past | Accepting new patients |
Locations
164 S 5th St
Montpelier, ID 83254
Phone (208) 847-1630
822 Washington St
Montpelier, ID 83254
Phone (208) 847-4404
455 Washington St
Ste 2
Montpelier, ID 83254
Phone (208) 847-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-1243 | ID | Yes |
Addresses
Primary practice location
455 Washington St Ste 2
Montpelier, ID 83254-1600
Mailing address
455 Washington St Ste 2
Montpelier, ID 83254-1600
Phone (208) 847-4464
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 805405600 | Medicaid | ID | |
| 804083400 | Medicaid | ID | |
| 8C493 | Other | ID | LCSW |
Other providers in Montpelier, ID
- Anthony Stafford Ruud
- Steven D. Hammond DDS PA
- Matthew Brinton Stevens
- Doris Faye Thornock
- Robert John Timothy
- Valley Home Oxygen
- Dean A Wallentine
- Kasey L Ward
- Mina L Wayman
- Whitney Marie Weborg
All providers in Montpelier, ID · Clinical Social Worker in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.