Judith Denise Sutherland, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

53473 Issued in TX

Practice address

2990 N Broadway Ave
Tyler, TX 75702-2149

Phone

(903) 535-9041

NPI assigned

Jun 4, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Clinical Social Worker

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tyler Family Circle of CareGroup PAC ID 4587812888, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Tyler Family Circle of Care

  dba Family Circle of Care

  • Federally Qualified Health Center (FQHC)
  • Tyler, TX
  • NPI 1144575820
  Medicare reassignment Care Compare group
• Tyler Family Circle of Care

  dba Family Circle of Care

  • Community/Retail Pharmacy
  • Tyler, TX
  • NPI 1942011903
  NPD

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1851611503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 S FANNIN AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028204",
            "telephone_number": "903-535-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 N BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757022149",
            "telephone_number": "903-535-9041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1115 US Highway 259 S",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "TX",
            "postal_code": "756543629",
            "country_code": "US",
            "telephone_number": "903-392-8203",
            "fax_number": "903-392-8207",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4002 S Loop 256 Ste K",
            "address_purpose": "LOCATION",
            "city": "Palestine",
            "state": "TX",
            "postal_code": "758018402",
            "country_code": "US",
            "telephone_number": "903-729-3015",
            "fax_number": "877-547-2231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "JUDITH",
        "middle_name": "DENISE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-04",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "53473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203375501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Surgical Associates of East Texas, LLP
• Bhavani Choudary Suryadevara, M.D.
• Kathryn Sustaita
• Sheryl Sutfin, FNP-BC
• Angela Sutherland
• Elizabeth Whitney Sutliff, MD
• Cindy Sutton, PT
• Erin Sutton
• Katy Sutton, FNP
• Suzanne Brians Counseling, LLC

• Clinical Social Worker in Tyler, TX
• Providers in Tyler, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.