Individual provider Active NPI

Kylie S Laughlin, LISW

  • Social Worker
  • Fremont, OH
National Provider Identifier
1457618332
Registry record updated Feb 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
I.0900367 Issued in OH
Practice address
1479 N River Rd
Fremont, OH 43420-9760
Phone
(419) 355-9440
Fax
(419) 355-9443
NPI assigned
Apr 18, 2012
Last updated
Feb 12, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2015

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 I.0900367 OH Primary

Addresses

Primary practice location

1479 N River Rd
Fremont, OH 43420-9760

Mailing address

PO Box 378
Sandusky, OH 44871-0378
Phone (419) 609-1112

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidOH

Other names 1

  • Kylie S Davis Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20120611000178 OH Practitioner - Clinical Social Worker 4082878723 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1479 N River Rd
Fremont, OH 43420-9760
Phone (419) 355-9440

Merit-based Incentive Payment System (MIPS)

Final score
80.23 of 100Reported as group
Quality
59.13
Promoting interoperability
99
Improvement activities
40
Cost
75.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.0900367OHMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Ohio Medical Specialists LLC CurrentSince May 7, 2012 Accepting new patients
Northern Ohio Medical Specialists, LLC CurrentSince May 7, 2012 Accepting new patients

Locations

1479 N River Rd
Fremont, OH 43420
Phone (419) 355-9440

2500 W Strub Rd
Ste 300
Sandusky, OH 44870
Phone (419) 624-1277

3004 Hayes Ave
Sandusky, OH 44870
Phone (419) 625-2841

Organizations & group practices 2

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": "1334707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423699200000",
    "number": "1457618332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 378",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448710378",
            "telephone_number": "419-609-1112",
            "fax_number": "419-609-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1479 N RIVER RD",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434209760",
            "telephone_number": "419-355-9440",
            "fax_number": "419-355-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUGHLIN",
        "first_name": "KYLIE",
        "middle_name": "S",
        "credential": "LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-18",
        "last_updated": "2015-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.0900367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIE",
            "last_name": "DAVIS",
            "middle_name": "S",
            "credential": "LISW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fremont, OH

Sources for this page

Verify at the official NPI Registry.