Individual provider Active NPI

Theodore M Lineberry, CSW

  • Clinical Social Worker
  • Louisville, KY
National Provider Identifier
1831979533
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
258812 Issued in KY
Practice address
950 S 1St St
Louisville, KY 40203-2202
Phone
(502) 585-9444
Fax
(502) 585-9466
NPI assigned
Oct 2, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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 258812 KY Primary

Addresses

Primary practice location

950 S 1St St
Louisville, KY 40203-2202

Mailing address

950 S 1St St
Louisville, KY 40203-2202
Phone (502) 585-9444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20240429002519 KY Practitioner - Clinical Social Worker 4981044609 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bridgehaven, Inc.Group PAC ID 9436122629, 6 clinicians

Practice addresses (Care Compare)

950 S 1St St
Louisville, KY 40203-2202
Phone (502) 585-9444

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bridgehaven, Inc. CurrentSince Apr 24, 2024 Accepting new patients
US Psychiatry PLLC PastSince Oct 8, 2023 Accepting new patients

Locations

950 S 1st St
Louisville, KY 40203
Phone (502) 585-9444

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": "1696204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1831979533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 S 1ST ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402032202",
            "telephone_number": "502-585-9444",
            "fax_number": "502-585-9466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 S 1ST ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402032202",
            "telephone_number": "502-585-9444",
            "fax_number": "502-585-9466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINEBERRY",
        "first_name": "THEODORE",
        "middle_name": "M",
        "credential": "CSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-02",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "258812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.