Benjamin L Tidwell, LCSW, CCDP-DIPLOMATE

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1283C Issued in AR

Practice address

5905 US 301 S
Riverview, FL 33578-3800

Phone

(866) 389-2727

NPI assigned

Jul 30, 2006

Sex

Male

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 AR, FL2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Chenal Family Therapy PLCGroup PAC ID 8325395627, 39 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 and National Provider Directory roles.

• Chenal Family Therapy, PLC

  • Mental Health Counselor
  • Little Rock, AR
  • NPI 1356604219
  Medicare reassignment Care Compare group NPD
• Blue Moon Senior Counseling

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1205129186

  FL

  Medicare reassignment NPD
• BMSC Az LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1497201875

  AR

  Medicare reassignment NPD
• Transitions Counseling Clinic PLC

  • Professional Counselor
  • De Queen, AR
  • NPI 1902501281

  Clinical

  NPD (past)

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1861407520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 GOFF ST",
            "city": "VILONIA",
            "state": "AR",
            "postal_code": "721739315",
            "telephone_number": "501-580-0116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 US 301 S",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783800",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "502 Richie Rd",
            "address_purpose": "LOCATION",
            "city": "Cabot",
            "state": "AR",
            "postal_code": "720233309",
            "country_code": "US",
            "telephone_number": "501-941-0940",
            "fax_number": "501-941-1875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "BENJAMIN",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "LCSW, CCDP-DIPLOMATE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "1283C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "175962795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasmine Thompson
• Sara Thompson, PMHNP-BC
• Thomia Thompson
• Alia Samari Thornton
• Thrive & Rise Therapy LLC
• Florence Tillman-Harris
• Chelsea Noelle Mira Timonera, PA-C
• Jan Marie Tinder, P.T.
• Jamila Rashel Tippit
• Anita Titus, MD

• Clinical Social Worker in Riverview, FL
• Providers in Riverview, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.