Individual provider Active NPI

Ryne Laxton

  • Social Worker
  • Gaithersburg, MD
National Provider Identifier
1326469206
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
18885 Issued in MD
Practice address
16220 Frederick Rd
310
Gaithersburg, MD 20877-4039
Phone
(301) 345-1022
NPI assigned
Dec 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 18885 MD Primary

Addresses

Primary practice location

16220 Frederick Rd
310
Gaithersburg, MD 20877-4039

Mailing address

16220 Frederick Rd
310
Gaithersburg, MD 20877-4039
Phone (301) 345-1022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20170828003574 MD Practitioner - Clinical Social Worker 5991077885 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18885MDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Tidemark Intervention Services CurrentSince Aug 1, 2020 Accepting new patients
Tidemark Behavioral Health Current Accepting new patients
Tidemark Intervention Services CurrentSince Aug 1, 2020 Accepting new patients
Tidemark Intervention Services Past Accepting new patients

Locations

7822 Eastern Ave
Baltimore, MD 21224
Phone (443) 596-8178

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1387411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1326469206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16220 FREDERICK RD",
            "address_2": "310",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208774039",
            "telephone_number": "301-345-1022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16220 FREDERICK RD",
            "address_2": "310",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208774039",
            "telephone_number": "301-345-1022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAXTON",
        "first_name": "RYNE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-19",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "18885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

Verify at the official NPI Registry.