Active NPI
Michael Medlin, LCSW
- Clinical Social Worker
- Wilton Manors, FL
National Provider Identifier
1871855528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW16220
- Practice address
- 2720 NE 8TH Ave Apt 5
Wilton Manors, FL 33334-2528 - Phone
- (786) 877-4395
- NPI assigned
- Jun 8, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CSW004836 | GA | |
| Clinical Social Worker | 1041C0700X | SW16220 | FL | Primary |
Addresses
Primary practice location
2720 NE 8TH Ave Apt 5
Wilton Manors, FL 33334-2528
Mailing address
2720 NE 8TH Ave Apt 5
Wilton Manors, FL 33334-2528
Phone (786) 877-4395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW16220 | FL | MD | Clinical Social Worker |
| CSW004836 | GA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- michaelmedlin@tdh.allscriptsdirect.net
Organizations & group practices 1
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": "1339113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591920000000",
"number": "1871855528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2720 NE 8TH AVE APT 5",
"city": "WILTON MANORS",
"state": "FL",
"postal_code": "333342528",
"telephone_number": "786-877-4395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 NE 8TH AVE APT 5",
"city": "WILTON MANORS",
"state": "FL",
"postal_code": "333342528",
"telephone_number": "786-877-4395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLIN",
"first_name": "MICHAEL",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-08",
"last_updated": "2020-06-12",
"certification_date": "2020-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "GA",
"license": "CSW004836",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW16220",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilton Manors, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.