Individual provider Active NPI

John Lott III, ISW

  • Clinical Social Worker
  • Leesburg, FL
National Provider Identifier
1639133531
Registry record updated Apr 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW 3084 Issued in FL
Practice address
2020 Talley Rd
Leesburg, FL 34748-3426
Phone
(352) 315-7850
Fax
(352) 360-6582
NPI assigned
Apr 17, 2006
Sex
Male
Sole proprietor
Yes

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
Clinical Social Worker 1041C0700X ISW 3084 FL Primary

Addresses

Primary practice location

2020 Talley Rd
Leesburg, FL 34748-3426

Mailing address

200 S Central Ave
#16
Umatilla, FL 32784-9566
Phone (352) 315-7850

Other identifiers 1

IdentifierTypeStateIssuer
765642400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20170221000217 FL Practitioner - Clinical Social Worker 1759665649 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ISW 3084FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cotler Healthcare & Development Inc. CurrentSince Sep 19, 2025 Accepting new patients
Lifestream Behavioral Center Inc Past Accepting new patients

Locations

901 S 62nd Ave
Hollywood, FL 33023
Phone (954) 893-0109

9835 Lake Worth Rd
Ste 16179
Lake Worth, FL 33467

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1639133531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S CENTRAL AVE",
            "address_2": "#16",
            "city": "UMATILLA",
            "state": "FL",
            "postal_code": "327849566",
            "telephone_number": "352-315-7850",
            "fax_number": "352-360-6582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 TALLEY RD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483426",
            "telephone_number": "352-315-7850",
            "fax_number": "352-360-6582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOTT",
        "first_name": "JOHN",
        "name_suffix": "III",
        "credential": "ISW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "ISW 3084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "765642400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.