NPIMap

Organization Active NPI

Tidemark Intervention Services

  • Clinical Social Worker
  • Baltimore, MD
National Provider Identifier
1720595242
Registry record updated Aug 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
18885 Issued in MD
Legal business name
TIDEMARK INTERVENTION SERVICES
Practice address
7822 Eastern Ave
Baltimore, MD 21224-2115
Phone
(443) 596-8178
NPI assigned
Jan 5, 2018
Last updated
Aug 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2022

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

Authorized official

Name
Ryne Laxton, LCSW-CNPI 1326469206
Title
Ceo
Phone
(484) 432-7882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 18885 MD Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

7822 Eastern Ave
Baltimore, MD 21224-2115

Mailing address

7822 Eastern Ave
Baltimore, MD 21224-2115
Phone (443) 596-8178

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201111002065 MD Part B Supplier - Clinic/Group Practice 7911317441 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
Practice locations: Baltimore, MD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

919 Back River Neck Rd
Essex, MD 21221
Phone (240) 329-4359

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1720595242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7822 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242115",
            "telephone_number": "443-596-8178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7822 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242115",
            "telephone_number": "443-596-8178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEMARK INTERVENTION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-05",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "LAXTON",
        "authorized_official_first_name": "RYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "484-432-7882",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "18885",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.